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THE 



SURGICAL, MECHANICAL, AND MEDICAL TREATMENT 

OF-l 

THE TEETH. 



LONDON: 
WALTON AND MITCHELL, 
Waidour-st., Oxford-st. 



THE 

SURGICAL, MECHANICAL, AND MEDICAL 
TREATMENT 

OF 

THE TEETH: 

INCLUDING DENTAL MECHANICS. 

ILLUSTRATED WITH 

ONE HUNDRED AND THIRTY-NINE ENGRAVINGS, 

(DRAWN BY mix ROFFE, AND EXECUTED BY TV. CLEGHORN.) 

BY 

JAMES ROBINSON, 

SURGEON -DENTIST TO THE METROPOLITAN HOSPITAL, LECTURER ON THE ANATOMY, 
PHTSIOLOGY AND PATHOLOGY OP THE TEETH, HONORARY DOCTOR OF 
DENTAL SURGERY OF THE BALTIMORE COLLEGE OF 
DENTAL SURGEONS, ETC., ETC. 



LONDON: 

W. WEBSTER, 60, PICCADILLY; 
LINDSAY AND BLAKISTON, PHILADELPHIA, U.S. 

1846. 



\ 



" DENTIUM CUR AM HABETO, UT BENE DIGERAS, ET DIU VIVAS. 
(BAGLIVI, OPERA, PIXELS EDITION, p. 112.) 



" NO ART IS COMPLETE, UNLESS ANOTHER ART, THAT OF CON- 
STRUCTING THE TOOLS AND FITTING THEM FOR THE PURPOSES OF 
THE ART, IS EMBODIED IN IT." (JOHN MILL, A SYSTEM OF LOGIC, 
INTRODUCTION, § 7.) * 



CONTENTS. 



Page. 

Preface 1 

PART I. 

THE SURGICAL, MECHANICAL, AND MEDICAL TREATMENT OF 
THE TEETH. 

1/ Chapter I. The History of the Dental Art. 

Dental Surgery among the Ancients 7 

The use of Artificial Teeth by the Egyptians, Greeks and Romans 9 

Ancient Instruments for Extracting Teeth „ 

Works published during the 16th, 18th, and 19th Centuries .... 13 

Dental Surgery in England and America 14 

Modern Odontologists 16 

Chapter II. The First Set of Teeth. 

No precise time can be fixed for their appearance 17 

Children born with Teeth ,, 

Their formation and position, and their number at birth 18 

Deposit of the Enamel 

Growth of the Teeth . . . ,, 

Order in which they come 19 

This order varies ,, 

General appearance of the First Set of Teeth 20 



VI 



CONTENTS. 



Infantile Diseases from Teething. Page 

Favourable and unfavourable symptoms during teething 21 

Constitutional derangement during, how caused 

Reproduction of hereditary diseases, Consumption, Scrofula, &c. 22 

Bad effect of Opiates on Children teething 23 

Lancing the Gums, &c 

Progress of the Second or Permanent Teeth in the 
Jaws, at the completion of the First. 

Number and position of the Permanent Teeth at six years of age. 24 
Connexion between the First and Second Teeth ,, 

Shedding the First Teeth. 

How accomplished by absorption 26 

The time of it, various ,, 

The First Teeth sometimes retained for forty and fifty years .... 27 
Order and time in which the Permanent Teeth usually pierce the 

Gum 28 

Case of abnormal position of the Wisdom Teeth ,, 

Chapter III. A comparative view of the Teeth of 
Man and Animals. 

Distinguishing marks of the Human Teeth 31 

Teeth of the Monkey 32 

Squirrel 33 

Lion and Sheep 34 

Chapter IV. The Causes of Irregularity of the Teeth. 

Temporary and permanent Irregularities 35 



CONTENTS. Vll 

Page. 

Irregularities only affect the Permanent Teeth 36 

Results of the too early extraction of the First Teeth 37 

The Mechanical Treatment of Irregularities of the 
Second Teeth. 

Importance of the subject 39 

Prevailing opinion of Dentists 40 

Novel methods employed by the Author 41 

Novel results in his practice ,, 

Case of Irregularity reduced late in life , , 

Ditto ditto 45 

Chapter V. Prevention of Irregularities of the Teeth. 

The necessity of preserving the First Set as long as possible ... 57 
Circumstances warranting a favourable prognosis respecting the 

second denture ,, 

Rules for Extracting the First Teeth 58 

The Dentist's assistance — when required ,, 

What teeth Irregularity mostly occurs in 59 

Various Malpositions 61 

Chapter VI. New Instruments for Expanding the 
Angles of the Jaws. 

Neglect of Dental Mechanics 63 

Description of our new Instruments 64 

The time most favourable for their employment 65 

Immobility of the Lower Jaw. 

It arises from cutting the Wisdom Teeth, and other causes .... 66 

Mechanical Treatment of it 67 



viii 



CONTENTS. 



Chapter VII. The Colour of the Teeth a Test of 



Consumption, fyc. 

Page. 

Family Likenesses extend to the Teeth 68 

Reproduction of hereditary Diseases 

Period when symptoms of Consumption may be detected 69 

Necessity of early remedies ,, 

Newness of the subject 

The Teeth vary in Colour and Character with the general health 

and constitution 70 

Their general uniformity and undiseased conditions in Animals . . 

Their importance in medical science and diagnosis 71 & 73 

Observations of Authors 71 

Their external appearance in Consumptive and Scrofulous Persons 70 

Their Colour in health, disease and death 72 

Propriety of early examining Children's Teeth to detect hereditary 

Diseases 73 

Distinctive Colour of the Tartar in consumptive patients 76 

General remarks on the Nails and Hair in the same 77 

High rank of the Teeth among diagnostic organs 

Coloured Drawings of the consumptive tints 78 

Do the Teeth indicate the Age ? 

Investigation undertaken to determine the point ,, 

The development of the Teeth depends upon the health, habits 

and constitution of the individual 79 

The Teeth of the Horse 80 

The Teeth do not serve to indicate the age 82 



Chapter VIII. The Cause of Caries. 

It is not satisfactorily established 84 



CONTENTS. ix 

Page. 

The investigations and opinions of previous Writers 85 

The Author leans to the chemical theory as a partial statement of 

the cause 92 

The Causes and Treatment of Tooth-ache. 

Variety of kinds of Tooth-ache 93 

The Dental Nerves, how protected in health 94 

Exposure and suppuration of the Nerve „ 

Abscess in the Internal Cavity 

Inflammation of the Periosteum 96 

Fungus of the Pulp ,, 

General Treatment 97 

Proximate cause of the peculiar pain of Tooth-ache 

Reasons why Tooth-ache betokens Pregnancy 98 

Treatment of Tooth-ache from exposure of the Nerve 

From other causes 99 

Chapter IX. Stopping. 

Importance of early attention to Carious Teeth 102 

The most favourable time for Stopping 103 

Preparing the cavity for the Operation 104 

Excavating Carious Portions. 

The Operation 105 

Instruments employed ,, 

Method of introducing Gold 106 

Use of Indian Rubber in some cases 107 

Materials used for Stopping. 

Gold 108 



X 



CONTENTS. 



Page. 

Silver 109 

Platina 

Tin 

Chemical inapplicability of nearly all Stopping but Gold 

Mineral Cement 110 

Fusible Metal 

Mineral Marmoretum, Succedaneum or Petroleum 

Terro-metallic Cement Ill 

Anodyne Cement , , 

Vegetable Cements „ 

Asbestos Stopping. 

Peculiar Character of this Mineral 112 

Cases for its employment 

Chapter X. Alveolar Abscess aud Gum-boil. 

Various causes of it 114 

Constitutional derangement of the Nerves of the Head and Face . 115 

Treatment ; 

Cases recited 116 

Dangers of the disease in the Upper Jaw 120 

Filing. 

Importance of Filing early in Caries 121 

What Teeth mostly admit of the operation 123 

Rules for the operation 122, 123 

After treatment 124 

Chapter XI. Salivary Calculus or Tartar. 

Its most frequent position in the mouth 126 



CONTENTS. Xi 

Page. 

Chemical analysis 127 

Microscopic analysis >> 

Animalcules ,, 

Three grand varieties of Tartar 128 

Its most frequent position on the Teeth 130 

Its injurious effects on the Teeth and Gums 131 

Its offensiveness to others , , 

Scaling. 

The operation „ 

Bad effect of Mineral Acids when employed against Tartar .... 134 

Guarding the Teeth against Acid Medicines. 

Their effects on the Teeth 135 

Method of taking them medicinally without injury „ 

Chapter XII. Extraction and its Instruments. 

General observations 137 

The improved Forceps 1 38 

Cases for their employment 139 

Number and description of Forceps required for the whole 

series of Teeth 140 

Method of using them 143 

Accidents from their improper application 144 

The Key Instrument „ 

Description and application of it 145 

Accidents from its careless usage 146 



Extraction of Stumps. 

Instrument for the purpose 



Xll 



CONTENTS. 



Page. 

Method of using it 147 

New Instrument for extracting the six Front Teeth in certain cases . , , 
Method of using it 148 

Chapter XIII. Nervous Affections of the Face 
frequently mistaken for Neuralgia or Tic Doloureux. 

Connexion between the Nerves of the Teeth, Head, Neck and 

Face 149 

Periodical Neuralgia often depends on the Teeth ,, 

Neglect of medical men in not examining them 150 

Important Cases in proof 151 

Consultation with Medical Practitioners. 

The importance of consulting Medical Practitioners 155 

Chapter XIV. Value and Importance of the 
Teeth, $c. 

For Health 158 

For Mastication 159 

For the Sense of Taste 160 

For Digestion 161 

For Touch „ 

For Personal Appearance 162 

For Articulation 

For Hearing 163 

General Uses 165 

The best mode of studying the Teeth 166 

The Means of Preserving the Teeth. 

Cleanliness 167 



CONTENTS. Xiii 

Page. 

When Children should begin to use a Tooth-brush 169 

Various Brushes . 170 

Tooth-powders, Lotions, Tooth-picks 171 

Nuisance of Dirty Teeth 172 

Artificial Teeth. 

Their usefulness 174 

It depends upon their scientific application, purity of material, 

&c * 175 

Their various kinds , 177 

Substances employed for Artificial Teeth , , 

Human Teeth fixed in Bone (or Suction Teeth) . . . t ,, 

Hippopotamus or Dentine ,, 

Mineral Teeth 178 

French Mineral Teeth 179 

American Mineral Teeth , , 

Adapting them to the mouth „ 

Pivoted Teeth. 

Source of Pivoting 180 

The operation and after treatment 181 

PART IT. 

MECHANICAL DENTISTRY. 

Introductory Remarks ; 185 

Work-bench for Surgery, Tools, &c 190 

Preparing Wax for Impressions or Models 191 

New Apparatus, Lamp, &c, for the purpose 192 

Taking the Impression or Model .' 194 



xiv 



CONTENTS. 



Page. 



Model Tray 194 

Method of taking Impression, and withdrawing it from the Mouth 195 

Insertion of Iron Wire in Wax 196 

Casting Model in Plaster of Paris 197 



Method of 

Consistence of Material used 

Mixing the Plaster 

Separating the Plaster from the Wax 



Finishing the Model 198 

Preparing the Plaster Model ,, 

Casting Metallic Models 199 

Materials employed ,, 

Method of Casting 

Modelling Sand ,, 

Finishing the Model 200 

Taking Model in Lead „ 

Immersing the Lead Model in Melted Lead ,, 

To Alloy Gold for Plates 201 

Method „ 

Materials 202 

Rolling Mill „ 

Crucible, &c 

Wire Making , , , 

Description ,, 

Drawing Plate, &c 203 

Making Solder ,, 

Essentials , , 

Charcoal for Soldering fJ 

Soldering Lamp 204 

Common Gas 

Blow Pipe ,, 



CONTENTS. XV 

Page. 

Blow Pipe with Bellows attached 205 

Annealing and Soldering 206 

Preparing Plate with Borax 207 

Fixing Clasp previous to Soldering 

Cleaning Gold Plates 208 

Making Plates to Models, &c, &c 209 

Cutting Pattern in Lead 

Cutting Gold „ 

Forming Plate 210 

Soldering Spring ,, 

Description of Lathe for Work-shop 212 

Emery Wheels ,, 

Choice of Teeth 213 

Fitting Teeth to Plate 

Insertion of Rivets 

Fastening Teeth to Plate 214 

Methods of Fastening the various Teeth to the Rivets 

Flos Silk, Sulphur, and Pewter Solder 215 

Finishing and Polishing the Plate ,, 

Brushes employed, Burnisher, and Powders ,, 

A Piece of Work finished with English Mineral 216 

Stockton's American Mineral Teeth ,, 

Mounting them on Gold Plate 217 

Soldering on Back 218 

Arranging them , 219 

Soldering to Plate ,, 

Boiling Piece when finished in Chemical Mixture 220 

Taking the Bite 221 

Observation on 222 

French Mineral Teeth „ 

Method of Mounting on Gold Plate 223 



XVI 



CONTENTS. 



Page. 



Backing the Teeth 223 

Method of, &c 

Pivoting Teeth 224 

Preparing Stumps 

Excising-Forceps, and Method of using them 

Files employed 225 

Pivoting Drill for destroying the Nerve 226 

A new Drill on the principle of the Helix-lever 227 

Rose-top Drill, for perfecting the Joint in certain cases 228 

Pivoting Natural Teeth 229 

Making Gold Screw ,, 

Adapting Tooth to Stump , 

Fixing in the Root 230 

Pivoting English Mineral Teeth ,, 

Fastening Tooth to pivot ,, 

Fixing it to Stump ,, 

Pivoting American Mineral Teeth 231 

Adjusting Tooth to Root ,, 

Description of pivot employed 

Fixing the Tooth , 

Pivoted Teeth on Gold Plate „ 

Cases requiring this method 232 

Taking Model ,, 

Inserting Peg in the natural opening of the Stump „ 

Casting and Preparing Model ,, 

Inserting the Pivot in the Plate 233 

American and French Mineral Teeth pivoted on Plate , , 

Observations „ 

Artificial Teeth set in Bone, or Suction Pieces 234 

Materials employed 235 

Cutting Tusk of Hippopotamus into Block , , 



CONTENTS. X\ T ii 

Page. 

Preserving its Enamel for Front Teeth 236 

Cutting it for Plain Bone or for the Insertion of Teeth 

Fitting the Block to the Models 

Preparing the Model „ 

Application of the Bone to the Model 

Fitting down the Bone 237 

Reducing the Block 

Fitting the Piece in the Mouth 238 

Method of. „ 

Adapting to the Bite , , 

Shape and Size of Piece for the Upper and Lower Jaw „ 

Fitting in the Teeth 239 

Method of 

Shaping different kinds of Teeth 

Fitting Central Teeth ,, 

Number of Teeth usually Inserted „ 

Observations on adjusting the two Central Teeth 240 

Fixing the Teeth 242 

Polishing the Bone 

Drilling hole for Pivot , , 

Use of Washer on Rivet 243 

Rivetting Gold Pin „ 

Natural Teeth inserted in Bone 

Carving Teeth with Enamel Fronts 244 

Carving Teeth in Bone 

Mounting Gold Plates with Mineral or Natural Teeth on Bone 

Sockets 

Adjusting Teeth to Bone „ 

Securing the Bone to the Model 245 

Shaping the Gold Plate , 

For the Insertion of Eight or Ten Teeth on this Principle 



xviii 



CONTENTS. 



Page. 

Fastening Plate to Socket 246 

Colouring the Bone to represent the Human Gum » 

Preparing the Sides of the Pieces for Spiral Springs 247 

Making Spiral Springs 248 

Wire Employed 249 

Size of Wire 

Apparatus for making Spring „ 

Fixing the Springs 250 

Making the Swivels 

Fastening Swivels to Plates 251 

Cases requiring this method of fastening the Plates , , 

Soldering to Plate 252 

Position for Fixing the Springs 

Artificial Teeth upon Engraved Suction Plates 253 

Directions for engraving the Plate 254 

Tools Employed 

Method of supporting the Plate, and Observations 

Surgical Treatment of the Mouth, preparatory to 
the insertion of Artificial Teeth 256 

The Manufacture of Mineral Teeth 259 

Description of the Materials employed „ 

Chemical Composition , , 

Preparation ,, 

Substances for colouring Mineral Teeth 262 

Various colouring preparations 264 

Chloro-platinate of Ammonia ,, 

Metallic Platina 265 

Metallic Gold „ 



CONTENTS. xix 

Page. 

Per-oxide of Gold 265 

Purple Powder of Cassius . . . . , . 265 

Oxide of Titanium 267 

Oxide of Zinc 

Manganese 268 

Cobalt ,, 

Silver ,, 

Preparing and Mixing the Body and Enamel 

Ingredients for Mineral Blocks 270 

For Transparent Single Teeth 271 

For Enamels suitable to the previous Ingredients 272 

Fret Enamel 273 

Gum Enamel , 274 

Grades of Colour for the Ingredients of Mineral Teeth „ 

Grades of Colour for Enamels 275 

Moulding Mineral Teeth 276 

Moulding Mineral Blocks 277 

Baking and Enamelling 278 

Firing 281 

To separate Silver, Gold, and Platinum from 
Foreign Bodies 284 

Cases that occur in Practice 288 

Insertion of Six Front Teeth with Pivots on Gold Plates 289 

Single Teeth on Plate 290 

Injurious effects of Wires 

Rules to be observed 291 

Methods for the Insertion of Bicuspid Teeth 293 



XX 



CONTENTS. 



Page. 

Insertion of Two Central Teeth 294 

Four Front Teeth 295 

First Bicuspis on either side ,, 

Top Piece, in which one Tooth remains in the 

Mouth 296 

Top Piece, in which Two Teeth remain 

Artificial Palates 297 

Simple and Compound , 

Method of constructing Plate in Simple cases 298 

In Compound cases 299 

Dentonomy and its Practical Importance 301 

Its practical bearing on Dentistry 302 

Neglect of it by Dental Px-actitioners 304 

Division of the Subject 305 

Observations 306 

Dental Education 308—317 

Glossary , 319 



PREFACE. 



In submitting the following Work on the Teeth to 
the suffrages of the profession and the public, the 
author may be allowed to make a few remarks in 
explanation of its nature and scope. 

If it be right to measure value by utility, then the 
teeth will take high rank among the parts of oar 
outward system. For their offices are sufficiently 
universal. Thus they perform the first process on 
the food, being indispensable to adult digestion; 
and by comminuting the same, they minister to the 
sense of taste, which is null and void unless objects 
be reduced to a size adequate to the gustatory sen- 
soria : moreover their soundness is essential to com- 
fort in eating : and again, their healthy state and 
regular position are requisite to beauty in man and 
woman, and to the perfection of the voice. These 
considerations, which might easily be extended, are 

B 



2 



PREFACE. 



enough to justify any one in making the teeth a dis- 
tinct object of attention. 

Accordingly, it is not surprising that a multitude 
of works have been written on the teeth. Indeed 
the number is so great, that it may seem as if the 
field were sufficiently occupied, without the present 
attempt. A little consideration, however, will serve 
to shew that this is not the case. 

In the first place, we must not be deceived by 
mere number of books, which is often no test of the 
quantity of useful information existing upon a given 
subject : moreover if we estimate by original matter, 
putting aside those publications that are but copies 
of others, we shall find that the number of standard 
works on dentism is by no means great. In the 
second place, in England, even from works of admitted 
excellency, that basis of the dental art, — the mechan- 
ical branch, — has been hitherto excluded. 

Without desiring in any way to disparage the ad- 
mired labours of others, we have, in our work, en- 
deavoured to give our own observations in preference 
to copying from sources already extant : and it has 
also been our aim to write in common terms wherever 
it was possible. For the time has come when the arts 
and sciences should be appreciated by the public, 
which will hardly think worse of the professions for 



PREFACE. 



3 



ceasing to speak an unintelligible language. As 
however it is impossible wholly to avoid techni- 
calities, we have appended to the volume a Glossary 
of those we have been constrained to use. 

Part I. of the work contains the anatomical and 
surgical department of the dental art \ and teaches 
the means of treating the teeth when diseased, of 
turning them to the best account in cases of partial 
decay, and otherwise of keeping them in health and 
beauty. The illustrations to this Part, which are 
numerous, are particularly necessary, as some of the 
subjects and cases that have occurred to the author 
in the course of an extensive public and private prac- 
tice, and which he desires to place prominently before 
the reader, are, it is believed, new, and could not so 
well be understood by a bare description. 

Part II., which is intended rather for the student 
and practitioner than for the general reader, contains 
the art of mechanical dentistry with all the improve- 
ments of the present day. Each process of manipula- 
tion connected with the teeth is described and illus- 
trated. The various kinds of artificial teeth are also 
treated of, and the means of adapting and fixing them 
are shewn, not only by words, but by suitable diagrams 
and wood-cuts. In this department of the book, it 
has been the author's aim to raise the character of 

b 2 



4 



PREFACE. 



the dentist as a mechanician, and to carry whatever 
useful or peculiar knowledge he himself may possess to 
the doors of all his worthy brethren in the profession. 

In conclusion it may be observed, that the import- 
ance of the dental art, and the consequent success of 
skilful dental practitioners, has attracted into the 
profession a number of persons of dubious character, 
who are rather studious of gain, by whatever means 
obtained, than of honestly practising their assumed 
calling. Dentistry, however, is not peculiar in this, 
for it is a common complaint in all professions. The 
fact has distinctly influenced our intentions in the 
following pages. We have hoped, by combining 
perspicuity with a full and detailed consideration of 
our art, to furnish some safeguard to the public 
against the class of persons before hinted at : and for 
this purpose we have pointed out some of the inde- 
fensible practices of which they are guilty ; such as 
the substitution for gold of other metals electro-gilt ; 
the employment of impure gold, &c, &c, &c. 

It is our belief that all the professions exist prima- 
rily for the public, and this is the only reply we can 
make to any who may think that we have too ex- 
plicitly divulged the secrets of our noble art. 

7, Gower Street, Bedford Square, 
June, 1846. 



PART I. 



THE SURGICAL, MECHANICAL, AND MEDICAL TREATMENT 
OF THE TEETH. 



PART I. 



THE SURGICAL, MECHANICAL, & MEDICAL TREATMENT 

OF 

THE TEETH. 
CHAPTER I. 

THE HISTORY OF THE DENTAL ART. 

The origin of medicine, like that of many other arts, 
is involved in considerable obscurity. To heal the 
sick, mitigate the pangs of suffering humanity, and 
stand between disease and death, were considered 
god-like attributes ; and therefore the ancients, who 
leant to the theological rather than to the natural 
truth of things, affirmed medicine to be a divine 
emanation, and impersonated it firstly in ApoUo, and 
next in his son ^Esculapius ; and thus its early his- 
tory is mixed up with mythology and poetry. 

Although we cannot imagine a state of society so 
happy as to be free from pain, disease, and death ; 
although accidents, the changes incident to the growth 
and decay of the human body, the invasions of pesti- 
lence and the casualties of battle, must at aU times 



8 



HISTORY OF THE DENTAL ART. 



have called attention to medicine, and rendered the 
practice of the art a necessity, still we have no 
authentic history of its rise and early progress. 

Eusebius mentions Athotes, an Egyptian monarch, 
as having written several treatises on anatomy ; but 
the existence of this king is doubted by others : and 
Thouth, an Egyptian, who according to Diodorus 
lived b.c. 2000, is generally supposed to be the first 
who wrote on medicine, which in his time was not 
cultivated as a separate art, but was practised in- 
discriminately by priests and warriors, poets and 
philosophers. 

Although the increase of luxury, and consequently, 
of attention to personal appearance, must have ren- 
dered the subject of dentistry one of considerable 
importance ; and although the eye and ear had long 
been objects of particular observation and separate 
practice; yet it is not till the time of Hippocrates 
that we meet with any notice of the diseases of the 
teeth, or of those who practised the art of dental 
surgery. This is the more extraordinary, as the sig- 
nificance of these organs, — to say nothing of their 
ornamental or useful functions, — was acknowledged 
in a remarkable manner by the ancient Egyptians, so 
that one of their most severe and infamous punish- 
ments consisted in the abstraction of a front tooth. 



HISTORY OF THE DENTAL ART. 



9 



There is no doubt, however, that the manufacture of 
artificial teeth, and other branches of dentistry, existed 
after a fashion, much earlier than history informs us. 
The loss of a front tooth, whether by disease or not, 
would naturally, under the circumstances of Egyptian 
law, give rise to unpleasant suspicions, and every 
exertion might be expected to be made to supply the 
deficiency. Accordingly, Belzoni and others have 
discovered artificial teeth in the sarcophagi of the 
Egyptians. These, it is true, are rudely made, and 
from being of wood, are ill adapted for performing 
mastication : nevertheless it may fairly be inferred, 
that their effect on the articulation of the voice, and 
the support they afforded to their natural brethren, 
would suffice to point out dentistry as a pursuit for 
the ingenious and mechanical. 

We have historical evidence, that in the palmy 
days of Greece and Rome, the diseases and general 
appearance of the teeth met with considerable atten- 
tion.* Aristotle speaks of forceps for extracting the 
teeth.f Pliny also and Martial mention various 

* At the commencement of the Christian era, we find, in the 
writings of Celsus, very explicit instructions respecting several import- 
ant operations on the teeth : and during recent excavations at Pompeii 
and Herculaneum, various dental instruments have been discovered, 
much resembling some of those in use at the present day. 

f " Queestiones Mechanicse," cap. xxii. 

B 3 



10 



HISTORY OF THE DENTAL ART. 



tooth-powders ; arid the "wearing of artificial teeth 
evoked the satire of more than one Roman poet.* 

Among the Greeks, a peculiar affection called 
stupor of the teeth, is particularly described, in con- 
nexion with the presence of tartar. This people 
looked upon dentition as a mysterious and significant 
event ; and those who died before its fulfilment were 
denied the funeral honours of the adult, and igno- 
miniously buried, instead of being burned in the 
usual manner. 

As a distinct art, however, dentism received but 
little attention from the ancients. The writings of 
Hippocrates and Galen, which formed the medico- 
dental text-books, contain receipts for electuaries, 
powders, and elixirs for beautifying the teeth, but 
nothing on what may be called the proper art and 
science of dentism. 

In the early part of the eleventh century, Albu- 
casis, an Arabian physician, wrote on diseases of the 
teeth, and gave drawings of a number of instruments 
used in his time for extracting, scraping, and the 
other dental operations then in practice. But it 
was not till the end of the sixteenth century that 
the art began to receive that undivided attention 

* Martial makes habitual allusions to artificial teeth as worn by the 
ladies of Rome in his time. 



HISTORY OF THE DENTAL ART. 



Il 



to which it is entitled both by its difficulty and 
usefulness. 

No less than thirty-eight treatises on the subject 
were published about that time. These abound 
indeed with what is nowise useful at present, but 
still the spirit that produced them is an evidence that 
the subject was beginning to be considered of im- 
portance, and that time and experience alone Avere 
required to raise dental surgery to its proper station 
among the arts. 

The first attempt to classify diseases of the teeth 
was made by M. Fouchard, of Paris, who has been 
denominated the Father of dental surgery. Before 
his time, the practitioners of the art seem to have 
considered the teeth merely in their mechanical 
phase, taking little account of them as complex 
organic structures, entering by their own vitality 
into the formation of the living body. M. Fouchard 
had the merit of directing attention not only to the 
construction and separate treatment of the teeth, but 
also to the indications which, in common with the 
adjacent parts, they furnish of the general health. 

This was an important advance in the subject. 
For that the teeth not only represent the apparent, 
but also the innate fundamental constitution of incli- 




12 HISTORY OF THE DENTAL ART. 

viduals, is unquestionable : nay, so intimately are 
beauty and firmness in these organs connected with 
health, that the celebrated Delabarre, (to whom we 
are indebted for an excellent work on the subject,) 
recommends those mothers who have constitutionally 
bad teeth, to refrain from suckling their children, 
lest they entail not only bad teeth but debilitated 
constitutions on their offspring; and he points out, 
that in choosing a wet-nurse, "her eyes should be 
lively and animated ; her hair and eyebrows brown or 
light-coloured; her lips red; her teeth sound and 
good ; her gums hard, and well coloured." 

We before mentioned that by the end of the six- 
teenth century, thirty-eight treatises had appeared on 
the teeth; but so much had the subject grown in 
consideration at the end of the eighteenth century, 
that no less than one hundred and fifty-eight works 
connected with it had then been given to the Euro- 
pean public. 

To enumerate these works would be inconsistent 
with our plan, but it may not be amiss to notice a 
few of the most important. Thus Bunon published 
in 1723, Mouton in 1746, Le Cluse in 1755, Bourdet 
in 1758, Bunon again in 1759. In 1766, the cele- 
brated work of Jourdain made its appearance, and 



HISTORY OP THE DENTAL ART. 



13 



in 1770 Thomas Berdmore produced a work on the 
teeth, which by its value and importance obtained 
him the appointment of dentist to George III. 

About this period, the famous John Hunter turned 
his attention to the subject, and presented the world 
with his " Natural History of the Teeth a produc- 
tion which, while it enlarged the sphere of dental 
knowledge, piqued the pride and roused the ambition 
of the English practitioners of the art. 

The inaugural Dissertation on the Structure of the 
Teeth of man and animals, published in 1798 by 
Robert Blake, gives evidence of the rapid strides that 
had been made in the anatomy and physiology of the 
teeth. This wOrk was soon followed by others, and 
at the commencement of the nineteenth century, the 
surgeon-dentists of this country were fully entitled to 
rank with the practitioners of the other branches of 
surgery. 

The most important of the works of our own time 
are those of Fox, 1803, Bell, 1829, Nasmyth, 1839, 
Owen, 1840 ; also those of Snell, Waite, Robertson, 
Jobson, and Koecker ; besides which, we might enu- 
merate several smaller works by Saunders, Clendon, 
White, and others, and many valuable detached 
papers in transactions and periodical publications. 

Within the last century, dentistry has advanced 



14 HISTORY OF THE DENTAL ART. 

far more rapidly in the United States than in any- 
other country. Thus we have Gardette in 1821, 
Parmly, L. S. Parmly, and Flagg in 1822, Trenor, 
1828, Fitch, 1829, Brown, 1833, Spooner, 1836, 
Goddard, 1843 ; and in 1845, Dr. Harris, one of 
the editors of the American Journal and Library 
of Dental Science, published a most able and com- 
prehensive work, entitled the Principles and Practice 
of Dental Surgery. And many other productions 
on the subject have appeared in America, and espe- 
cially in the periodical just alluded to. 

That some of the opinions of the ancients respect- 
ing the teeth should be useless for our purposes, is 
by no means surprising. Hippocrates describes them 
as glutinous extracts, from which the fatty part has 
been burnt up by heat, and affirms that they are 
harder than the other bones, because they have no 
heat in them. It is hard to appreciate the meaning 
of this at the present day. Aristotle, however, (who, 
as is usual on all subjects, has some excellent gene- 
ralizations respecting the teeth of man and animals,) 
declares them to be the only bones that grow through 
the whole of life ; because, as he says, they would soon 
be worn away by attrition, unless they were continu- 
ally renewed.* This at all events is intelligible and 

* " De Generatione Animalium," lib. ii., cap. vi. 



HISTORY OF THE DENTAL ART. 15 

suggestive, whatever may be thought of the conclu- 
sion which Aristotle deduces from it. He adds, that 
the growth is manifest in those teeth that have lost 
their corresponding opposites in the other jaw. 

Before concluding we may be allowed a word re- 
specting the present state of dental art and science. 
The conditions of success appear to be not different in 
this from what they are in other branches of know- 
ledge and practice. They are all summed up in one 
phrase, united labours. Whatever of discrepancy 
there is in the works of our chief authorities, is 
greatly owing to the isolation in which they studied, 
and to the want of a general means of collating their 
ideas. Again, whatever of progress we find in that 
country which takes the lead in the dental art, 
appears to be due to an absence of prejudice and 
jealousy which allows free communication of ideas, 
and association of common interests, among the 
members of the profession. For the association of 
dentists in America has not only given its members 
generally a status in society unknown to dentists else- 
where, — has not only repressed those characters who 
intrude themselves upon the public here, and given 
merit its station and honesty its preeminence, — but 
has also contributed largely to the advanced state in 
which dental science stands in the United States. It 



16 



HISTORY OF THE DENTAL ART. 



is painful to think that we do not yet possess the 
same advantages in England. The names of Harris, 
Brown, Parmly, Maynard, Greenwood, Goddard and 
Haydon, shine high over our heads in these respects, 
and present us with bright examples of brotherly 
good feeling, scientific excellence, and practical 
success. 



In modern days odontology has become a science 
separate from the dental art. This is because the 
philosophical value of the teeth is so great as to 
make them one of the grand means of classification 
in natural history and comparative anatomy. The 
microscopic structure of these organs has also been 
noted with great patience and powers of research. 
Among those who contributed to the general sci- 
ence of the teeth in the sixteenth, seventeenth and 
eighteenth centuries, Eustachius, Malpighi and Leeu- 
wenhoek stand preeminent; and among the best 
odontologists of our own time are Owen, Nasmyth, 
Goodsir, Miiller, the Cuviers, Rosseau, Purkenji, and 
especially Retzius. 



CHAPTER II. 



THE FIRST SET OF TEETH. 

Every parent should have at least a general know- 
ledge of the development and anatomy of the first 
teeth, not only from its scientific interest, but also 
from its great importance in the management of 
children. The time for their first appearance, as well 
as for many of the other processes of nature, is sub- 
ject to considerable variation. And although some 
authors have endeavoured to shew that the teeth 
furnish a test of age, yet there are many cases on 
record of children having been born with one, two, or 
more of these organs. Whatever history may sanction, 
Shakspeare committed no physiological error in attri- 
buting such a peculiarity to his hero, Richard, who 
is made to say, " I was born with teeth." The same 
is stated of Louis XIV., of France, in whom the 
presence of a tooth at his birth, seemed to forbode 
his future greatness. In our own day, Dr. Crump 
described before the American society of dental- 



18 



THE FIRST SET OF TEETH. 



surgeons, the case of a child whose jaws at birth 
exhibited the full deciduous denture. 

The deciduous or milk teeth, originally produced 
by a process of secretion, are contained within their 
alveoli or sockets at birth : the forms of ten of them 
of a bony substance being distinctly visible in either 
jaw. As ossification proceeds, they assume a more 
perfect character. Their investing membrane secretes 
a fluid, from which a white substance is deposited 
upon the pulp ; this is the enamel, which is at first 
of a consistence scarcely harder than chalk, but ac- 
quires such a degree of hardness by age, that a file 
is soon worn smooth in cutting it. 

After birth, the growth of the teeth is rapid, and 
they cannot long be confined within their alveolar 
cavities or cells. Still however, as before observed, 
the time of their outward appearance is uncertain, de- 
pending on the health and constitution of the child, 
and on a variety of other circumstances. During their 
growth, the fangs are the only parts that lengthen ; 
and as this takes place, the sockets grow around and 
more closely invest them. 

The twenty deciduous teeth — ten in the upper and 
ten in the lower jaw — generally make their appear- 
ance in the following order : — 



THE FIRST SET OF TEETH. 19 

The two lower, followed by the two upper centrals, 
from the 4th to the 8th month. 

The two lateral incisors in each jaw, from the 7th 
to the 11th month. 

The four anterior molars, two in each jaw, from 
the 12th to the 18th month. 

The four canines, two in each jaw, from the 16th 
to the 22nd month. 

The four posterior molars, two in each jaw, from 
the 19th to the 38th month. 

These furnish the complement of the deciduous or 
milk teeth, which are twenty in number, or ten in 
each jaw. 

But these dates are only approximate. We have 
seen children that have attained the age of twelve 
months, or even sixteen, without cutting a tooth; 
and Lefoulon mentions a young girl of seven years 
of age, whose lower central teeth had not appeared ; 
while on the other hand, as we before observed, there 
are many instances on record where children have 
been bom with teeth. 

Nature occasionally varies the order as well as the 
time in which the teeth appear ; sometimes the top 
incisors appear before those of the lower jaw ; at 
other times, the canine teeth precede the lateral. 

Perhaps, as a general rule, the first set of teeth 



20 INFANTILE DISEASES FROM TEETHING. 

may be said to be perfect by the third or fourth year, 
■when they present this appearance. 




INFANTILE DISEASES FROM TEETHING. 

The period of teething is one of pain and danger 
to the child, and of care and anxiety to the mother ; 
for though in favourable cases, the symptoms are 
slightly marked, and limited to swelling and red- 
ness of the gums, increased flow of saliva, and slight 
affection of the bowels, yet it frequently happens, 



INFANTILE DISEASES FROM TEETHING. 21 

that dentition is accompanied by signs of great 
constitutional derangement. 

Teething usually commences about the third or 
fourth month, and is marked by increased flow of 
saliva, the infant having a tendency to put every- 
thing within its reach into its mouth. After this 
state has continued a longer or shorter period, vary- 
ing from six to twelve weeks, the symptoms become 
more severe ; the gums swell, are inflamed and pain- 
ful, so that the child does not willingly allow them 
to be touched ; nay, sometimes refuses the breast. 

In bad cases, symptoms of constitutional irritation 
now commence ; the breathing becomes hurried and 
oppressed; the pulse quick and irregular, and the 
urine scanty and high coloured ; delirium may come 
on, and in many cases violent, and even fatal convul- 
sions may take place. 

How are all these effects produced ? The progress 
of the tooth is accompanied, or rather preceded, by 
the absorption of its investing membrane and of the 
gum ; and if the tooth be inclined to advance more 
rapidly than this absorption takes place, a degree of 
pressure is exerted against the membrane and the 
gum. This reacts upon the pulp or vascular portion 
of the tooth, and a degree of constitutional irritation 
is set up, more or less violent, according to the pres- 



22 INFANTILE DISEASES FROM TEETHING. 

sure exerted and the resistance offered to it : under 
which circumstances the constitution of the child 
may reproduce the latent seeds of consumption or 
scrofula, or of other diseases which may have laid 
dormant for generations; and thus either the little 
sufferer may be worn out by constant pain and irrita- 
tion, or his future health, strength, and perchance 
his intellects, may be irrevocably impaired. 

In one child we meet with hurried and oppressed 
respiration, giving evidence of congestion of the 
lungs : in another, the head is affected, and delirium, 
convulsions, or perhaps hydrocephalus is the result. 

Some infants have glandular swellings in the throat, 
with their concomitant evils ; others are worn out by 
the slow fire of irritative fever. 

This catalogue of infantine pains and miseries, 
fearful though it be, we are bound in honesty to set 
down, not, however, to alarm parents, but to shew 
that the process of teething is a most important one, 
and demands the greatest care and attention. 

Nature frequently throws off the excess of irrita- 
tion by means of her own, and thus it is that erup- 
tions on the skin, breakings out behind the ears, and 
diarrhoea, are constant accompaniments of dentition. 

While, however, we would urge upon mothers the 
duty of watching their tender infants through the 



INFANTILE DISEASES FROM TEETHING. 23 

whole of this period, we would strongly condemn 
undue interference with nature, and above all, the 
common recourse to opiates, in the form of Godfrey's 
Cordial, Johnson's Soothing Syrup, &c, &c, by 
which many more children are sacrificed than by the 
dangers of teething itself. 

The pain, swelling and redness of the gums, the 
eruptions on the skin, and the diarrhoea, may be con- 
sidered as natural symptoms of the process, or as 
efforts of nature to avert its dangers, and therefore 
they generally subside upon the appearance of the 
tooth. Unless then the diarrhoea be excessive, and 
the child appears sinking under its effects, it does 
not require any treatment; or at least is easily 
manageable by the simple operation of lancing the 
gum, and by giving small alterative doses of chalk 
and mercury, or some similar preparation. A tea- 
spoonful of castor oil will commonly be a far more 
efficient opiate than all the Godfrey's Cordials and 
Soothing Syrups that were ever invented. 

When the symptoms are severe, or the dentition 
protracted, medical aid should at once be called in, 
lest what is in itself a natural, and under proper 
management a safe, process, should lay the founda- 
tion of disease, pain and misery in the future. 



( 24 ) 



PROGRESS OF THE SECOND OR PERMANENT TEETH IN 
THE JAWS, AT THE COMPLETION OF THE FIRST. 

When all the deciduous or milk teeth are com- 
plete, and arranged in their respective places, and 
even before this, during the period of their growth, 
the second set is already in the course of preparation. 
In the whole of them ossification has considerably 
proceeded ; the four top and bottom front teeth are 
in an advanced state of formation ; the four anterior 
molars are nearly perfect, and the remainder are in 
different stages of development: while the rudiments 
of the wisdom teeth remain embedded in the alveoli. 

At the age of six years there are generally no less 
than forty-eight teeth in the two jaws: twenty deci- 
duous teeth, all perfect; and twenty-eight perma- 
nent teeth in various stages of evolution, and in 
separate and distinct cells, as represented in the 
following cut. On reference to this it will be ob- 
• served, that the whole of the second set lies some- 

what behind the first, and is confined in a narrower 
circle ; so that as the second set increase in size, they 
must necessarily crowd the jaw, and ultimately force 
the first set out of their places. Although the 
second teeth are in distinct cells, their connection 
with the first set is continued by means of a 



SECOND OR PERMANENT TEETH. 25 




cord (see plate), through a small opening at the 
bottom of the sockets of the deciduous teeth. This 
communication serves to supply the former with 
vitality ; viz., blood-vessels, arteries, and nerves : 
and hence the necessity of preserving the first teeth 
as long as possible, — a subject to which I shall more 
particularly allude when speaking of the causes of 
irregularity (pp. 36 — 39). 



SHEDDING THE FIRST TEETH. 

I shall not enter upon the various and conflicting 
opinions that have been broached on this subject, 

c 



26 SECOND OR PERMANENT TEETH. 

and which can only tend to confuse a matter really- 
simple ; but at once state the opinion of Mr. Bell, 
which seems to be the most rational one. He asserts, 
that as soon as the second teeth have advanced to a 
certain point of formation, and can no longer be 
contained within their own alveoli, absorption takes 
place in the anterior parietes of these cavities, by 
which means the teeth are allowed to come in some 
measure forward. In consequence of this absorption, 
it often happens that not only the socket of the cor- 
responding temporary tooth, but that of the tooth 
on each side also, is open to the permanent one. 

Absorption now commences at the root of the 
temporary tooth, generally on that part nearest its 
successor ; and this goes on by degrees as the latter 
advances, until the root is completely removed. The 
crown at length falls off, leaving room for the per- 
manent tooth to supply its place. 

The absorption of the root seldom, if ever, com- 
mences at its extremity, but generally at a consider- 
able distance from it, and often near the neck. 
When a portion of the root has been removed, it has 
somewhat the appearance of being broken; but a 
little observation will soon enable any one instantly 
to detect the difference. 

No precise time can be fixed when this important 



SECOND OR PERMANENT TEETH. 27 

change will take place, or when the deciduous teeth 
will be removed, and a more numerous and powerful 
set supply their places. Indeed, so little is this 
event subject to an invariable rule, that I have 
met with patients of thirty and even forty years of 
age, with one or more of the temporary teeth still 
remaining. 

The period varies considerably ; on the one hand 
we have the cases mentioned above, while on the 
other, a child of nineteen months and a half old has 
been known to have twelve of the second teeth, their 
growth entirely complete. In one instance, men- 
tioned in the Boston Medical Journal, it is stated 
that a lady, forty years of age, had two central and 
two lateral incisors inserted : three months afterwards 
she had these artificial teeth removed, and in four 
months more had four natural ones in their places. 

The same author observes : " I remember another 
case of a young lady, twenty -two years of age, who 
called on me some time since, and had a cuspid or 
eye-tooth put in on a plate. A short time afterwards 
she called at my office [surgery] , and requested me 
to fasten the plate, as it continually got loose. On 
inspection, I found a new cuspid making its appear- 
ance where it should have been twelve years before." 

In the majority of instances, however, the appear- 

c 2 



28 SECOND OR PERMANENT TEETH. 



ance of the second teeth takes place at from six 
to eight years of age, commencing with the first 
anterior permanent grinders, the cutting of which 
usually precedes the shedding of the two central 
incisors of the lower jaw. 

The following table will shew, as accurately as the 
subject admits, the order in which the permanent 
teeth appear : 



Years of Age. 

4 Anterior Molares from 6 to 7 

4 Four Central Incisores, two in each jaw „ 7 to 7£ 

4 Lateral Incisores, on each side of the preceding 7 to 8 

4 Anterior Bicuspides 8 to 9 

4 Posterior Bicuspides „ 10 to 12 

4 Cuspidati , 11 to 13 

4 Second Molares „ 12 to 14 

4 Third Molares (or Wisdom Teeth) „ 18 to 30 

32 



These latter teeth, however, do not always appear 
in the order above indicated, and moreover occasion- 
ally they come forth in the most singular positions. 

In the following cut it will be observed, that in- 
stead of the wisdom teeth being near the second 
molars at the back of the jaw (indicated by the white 
line), they have made their appearance considerably 
above, and out of, the natural situation. 



SECOND OR PERMANENT TEETH. 



29 




30 SECOND OR PERMANENT TEETH. 

the following plate exhibits the posterior surfaces of 
the incisores and canine teeth, and the grinding sur- 
faces of the bicuspides and molares of the upper and 
lower jaw : also a table of the time when they gene- 
rally make their appearance. 



X^PPEJR jaw. 



„ . %:'■- IS to 30 Years of AQ'e 




X.0WIE1R, JAW. 



OF 



CHAPTER III. 



A COMPARATIVE VIEW OF THE TEETH OF MAN 
AND ANIMALS. 

Amongst the numerous marks by which the human 
race is distinguished from the brute creation, the 
perpendicular arrangement of the front teeth of the 
lower jaw is one of the most decided ; for how- 
ever the human teeth may resemble those of ani- 
mals in size and position, the development of the 
chin shews that the erect posture is natural to man 
alone. In man again the teeth are of a uniform 
length and continuity of series; which is not the 
case as regards other animals, in which the canine 
teeth are observed to be of greater or less extent than 
the others, according to the wants of the animal. In 
the human being the hand supersedes the use of the 
teeth, whether considered as weapons of offence or 
defence, or as instruments for procuring food. 

The following figure represents a human skull in 
which the denture is perfect. 

If this be compared with that of the monkey, 
(which exhibits the nearest approach to the human 



32 COMPARATIVE VIEW OF THE TEETH OF MAX 




form,) it will be found that, while in both cases the 
teeth are equal in number, in the monkey the 
lower teeth diverge upwards and outwards instead 
of upwards perpendicularly j and that the canines are 
considerably longer than the others, and than those 
of the corresponding class in ftian. 



AND ANIMALS. 



33 



In the squirrel again we have a further con- 
firmation of the fact, that the teeth of all animals 
are developed according to their wants and habits. 




In this sketch it will be observed that there are 
only two front teeth, accompanied by a certain pro- 
tuberance in either jaw ; the bicuspides being defi- 
cient, and the molar es, which fill the back part of 
the jaw, being separated from them by a consider- 
able interval. 

Again, on comparing the skull and denture of the 
lion with that of man, it will be found that the 
canine and incisor teeth are strikingly different, par- 
ticularly the former ; which, being intended in the 
lion to rend and tear the prey, for the previous 
mastication of which the animal has no mechanical 
contrivances, are developed very strongly indeed. 

In the sheep, on the contrary, as the representa- 
tive of another class of animals, it is remarkable 

c 3 



34 



COMPARATIVE VIEW, ETC. 




that the front teeth in the npper jaw are altogether 
wanting. 




In short, we may take the whole animal creation, 
and we shall find the same appropriate arrange- 
ment ; proving incontestable that the teeth of all 
animals are peculiarly adapted to their several wants, 
habits, and necessities. 



CHAPTER IV. 



THE CAUSES OF IRREGULARITY OF THE TEETH. 

Irregularities of arrangement can only be said 
to affect the second set of teeth, and are of two 
kinds, temporary and permanent. The first kind arises 
from a too rapid advancement of the second teeth 
before a corresponding absorption of the first has 
taken place ; by which the second are forced into un- 
natural positions, and pierce the gum either before, 
behind, or in some cases on the sides of, the tempo- 
rary ones. The second kind of irregularity arises 
from the increased size of the second teeth as com- 
pared with the first, and from their coming forth be- 
fore a sufficient expansion has taken place in the jaws 
to permit of the teeth piercing the gum in a regular 
manner. 

These irregularities are chiefly confined to the 
front of the mouth, though cases do occur, and that, 
frequently, in which the bicuspides are affected in the 
above manner. Moreover many cases which at first 
come under the denomination of temporary, may, 
if allowed to continue beyond a certain time, become 



36 CAUSES OF IRREGULARITY OF TEETH. 

permanent : for example, when a second tooth pierces 
the gum either too anteriorly or too posteriorly, 
the consequence of which is the irregularity here 
represented. This would become a permanent 




deformity, unless recourse were had to certain me- 
chanical means which will be explained when we 
come to speak of the treatment of these cases. 

What are termed permanent deformities of the 
second denture arise from several causes ; as from a 
natural want of room in the jaws themselves to 
admit of the increased size of the second teeth ; from 
malformation of the teeth and jaws;* or from a 
deep declivity in the arch of the upper jaw and a 
contraction of its angles. 

The most serious cause of irregularity of the 
second teeth remains yet to be spoken of ; viz., 

* Some curious anomalies of the teeth are related by Pliny and 
Dr. Pritchard : the former mentions the case of Pyrrhus, King of 
Epirus, in whom all the crowns were united ; the latter states, that 
in a recent excavation, he discovered an ancient Roman skull, in 
which the teeth presented similar appearances. 



CAUSES OF IRREGULARITY OF TEETH. 37 

the too early extraction of the first teeth before 
the second are sufficiently developed to take their 
places ; which is frequently practised under the idea 
of preventing deformity. That this practice, how- 
ever, is more often the cause of permanent de- 
formities of the second denture than any other, 
may be easily proved. For how often do we meet 
with otherwise beautiful faces, the contour of which 
has been irremediably destroyed by it ! The prac- 
tice itself cannot be too severely reprobated; nor 
can those who indulge in it be allowed to remain 
within the pale of civilized dentism. 

What can be more painful than to see a naturally 
well-formed mouth permanently disfigured by the 
practitioner to whose care it has been entrusted, 
and who, with the professed design of preventing, 
actually entails an irremoveable deformity on his 
patient ? 

Many cases might be related in which the face has 
been permanently disfigured in this manner, but 
we shall content ourselves with a single illustration. 

A young gentleman, six years of age (the son of a 
nobleman), was taken to a dentist to have his 
mouth examined. All the first teeth were firm. The 
dentist, however, asserted that it was necessary that 
some of them should be removed, or an irregular 



38 CAUSES OF IRREGULARITY OF TEETH. 

permanent set would otherwise result. He very 
dextrously extracted eight front teeth, four from each 
jaw, and dismissed the patient with a wish to see him 
when the second teeth had come through. Twenty- 
two months, however, elapsed before this occurred \ 
and during the interval the alveolar processes had 
collapsed, and the teeth gradually made their appear- 
ance, some of them half-way down the jaw at the 
centre, others protruding at an angle of forty-five 
degrees. All this, it was asserted, would soon come 
right if a few more were extracted. The four canines 
and two temporary grinders were now removed. 
Thus in less than two years this operator had removed 
the whole of the front teeth ; and when I saw the boy, 
at which time he was thirteen years of age, his mouth 
was as represented in the annexed cut. The arch and 



MECHANICAL TREATMENT OF IRREGULARITIES. 39 



angles were beautifully developed, and allowed ample 
room for the increased size of the teeth. Now 
surely this is a lamentable case. The general reader 
will readily appreciate the false grounds of the 
practice itself, by referring to the wood-cut, p. 25, 
which shews the intimate connection between the 
first or deciduous and the second or permanent 
teeth. 



THE MECHANICAL TREATMENT OF IRREGULARITIES 
OF THE SECOND TEETH. 

There is no branch of the dental art on which 
there exists greater diversity of opinion than on the 
treatment of irregularities of the second dentition. 
Not only are mechanical contrivances constantly 
made use of, which are erroneous in principle, and 
consequently do harm instead of good ; but the time 
at which really useful means may be employed with 
advantage is by no means settled among dental prac- 
titioners. The subject is one of the greatest im- 
portance, not only as regards comfort and personal 
appearance, but the possession of a free and perfect 
enunciation. We shall therefore devote a chapter to 
its illustration. 



40 MECHANICAL TREATMENT OF IRREGULARITIES 

Numerous works have been written on the proper 
treatment of irregularities of the teeth; and each 
author, though differing from his brethren perhaps 
in everything else, lays down the principle that no 
alteration in the position of the teeth can be effected 
after the age of fourteen. 

Mr. Bell, indeed, mentions a patient, whom he 
successfully treated in a case of the kind between 
the ages of 19 and 20 ; but the prevailing opinion 
is, that it is useless to interfere with irregularities 
of the teeth after fifteen or sixteen years of age. 

I had, however, for some years been impressed 
with an opinion, that irregularities of the human teeth 
were susceptible of great improvement, if not of 
complete cure, at a much later period than the gene- 
rality of the profession seemed willing to allow ; and 
in this opinion I have since been confirmed by the 
successful results of practice. In the British Quar- 
terly Journal of Dental Surgery I first published a 
paper on the subject, which had the effect not only 
of altering the methods employed, but of fixing the 
time at which means may be used with complete 
success at a much later period of life than that com- 
monly assigned. 

I therefore subjoin the following cases, selected 
from many others, as illustrative of what may be 



OF THE SECOND TEETH. 41 

done in malpositions that would formerly have been 
thought hopeless. 




Case I. The above drawing represents the upper 
jaw of a gentleman, twenty-eight years of age, as it 
appeared when he first applied to me. 

The maxillary arch was contracted ; the palate more 
hollow than usual ; and the four incisors, but more 
particularly the right central and lateral, inclined so 
much inwards, that in shutting the mouth the under 
teeth came completely in front of the upper. 

The patient being a barrister, it was of moment 
that he should have this deformity removed, since 
it so interfered with the free use of his tongue, as to 



42 MECHANICAL TREATMENT OF IRREGULARITIES 

render his speech thick and inarticulate; and as 
the arts of elocution and persuasion are aided by a 
pleasing physiognomy, so the latter was of unusual 
consequence in the present case. When he first con- 
sulted me, I intimated to him, that provided he would 
submit to some inconvenience for at least three 
months, an attempt might be made to alter the mal- 
position of the teeth with a chance of success : at 
the same time I impressed upon him, that a favour- 
able result could not be relied on with any degree of 
certainty. He cheerfully consented to submit to 
the experiment, and expressed a wish, should it 
fail, to have the teeth extracted. Under these cir- 
cumstances, I determined to have an instrument 
made that should be free from the objections to 
which those hitherto used by Fox, Bell, and others, 
are liable. It consisted of a piece of hippopotamus 
(dentine) carefully fitted to a model of the anterior 
part of the palate and internal surface of the upper 
teeth, the edges being rounded off so as to make 
it as comfortable as possible to the tongue. It 
extended in the form of a bar behind the four 
incisors, beyond which it was flattened, so as to 
form at each extremity a sort of cap, which on 
the left side was carried over the crowns of the 
bicuspis and first molar tooth; and on the right, 



OF THE SECOND TEETH. 



43 



I " after passing over the bicuspides, accommodated it- 
self to the space left by the removal of the first 
molar tooth, which had been extracted at a former 
period. 




This arrangement fully answered the purpose of 
preventing the under jaw from closing in its former 
position; and the power of exerting the pressure 
requisite to force the irregular teeth into their proper 
places, was given by two pieces of strong gold wire 
screwed into the bone. Immediately behind those 
teeth these wires were turned and flattened, so as 
to present a button-like surface to the posterior 
aspect of the same teeth, with which they were 
brought into contact every time the mouth closed. 



44 MECHANICAL TREATMENT OF IRREGULARITIES 

The instrument was firmly retained in its place by- 
means of two broad clasps inserted into the bone, 
and fastened round the second bicuspides. 

This drawing represents the piece described when 
in the mouth. The patient wore it for six weeks ; 
at the expiration of which time the alteration in the 
direction of the teeth was so considerable, that the 
under teeth closed on the edges of the upper de- 
formed ones. 




In order to complete the cure, it was necessary to 
have a new piece made, considerably thicker at that 
part intended to exert pressure ; this was worn for 
seven weeks longer, when it was found to have fully 



Or THE SECOND TEETH. 



45 



accomplished its purpose. The patient did not com- 
plain of inconvenience while under treatment, and 
four years have now elapsed since the successful 
result was obtained, the teeth having permanently 
retained their improved position, as represented in 
the preceding cut. 

II. Another case which came under my care, shortly 
after the publication of the above, was that of a 
gentleman, 29 years of age, the son of one of our 
most eminent barristers. In this case the six front 
teeth in the upper jaw projected at an angle of nearly 
forty-five degrees, their edges being almost parallel 
with the tip of his nose, while there was a consider- 
able separation on each side of the mouth between 



46 MECHANICAL TREATMENT OF IRREGULARITIES 

the first bicuspid and canine teeth. The preceding 
wood-cut represents the position of the teeth at the 
time he applied to me. 

Here it will be observed that the mechanism em- 
ployed was the reverse of the preceding : thus a 
plate was made and accurately fitted to extend and 
cap the whole of the teeth, from the bicuspids on 
each side to the second molar or grinder ; on the 
plate of which was rivetted a small piece of hip- 
popotamus, to prevent the approximation of the 
jaws in their former position, and to act as a lever 
when they came into contact. On the inside of 
the mouth the plate extended behind the teeth, 
being cut away from the front against the irregular 
ones, as otherwise it would counteract the effect 
of a bar that was soldered on from the second 
bicuspis, and extended to the corresponding one on 
the opposite side, so as to produce the necessary pres- 
sure when the mouth was closed. This bar, which was 
highly polished, was adjusted in front to the project- 
ing teeth. When first applied, it required some slight 
pressure to get the teeth within the space of the 
bar and plate. This piece was worn for three days, 
at the end of which I saw my patient, and found 
that the projecting teeth had fallen back, and the 
plate had become so loose that there was a space the 



OF THE SECOND TEETH. 



47 



thickness of a sixpence between the bar and the 
teeth. To rectify this, I drilled holes in the bar, 
and fastened a piece of Indian rubber, and this was 
repeated from time to time as the teeth fell back. 

The patient continued to wear this plate for six 
weeks, when it was necessary that a new one should 
be made on the same plan, and again accurately fitted 
to the then position of the teeth. From time to 
time as the teeth went in, the Indian rubber was 
renewed. In less than three months the teeth were 
in their proper places, the bicuspides had closed on 
each side, and to the delight of the patient the whole 
contour of the mouth and face was completely 
changed. 

As, however, the teeth seemed disposed to return 
to their original position, he continued at my request 
to wear the last plate at night for two months ; since 
which, up to the present period, (and three years and 
a half have elapsed,) no change has taken place, nor 
is it now likely ever will. 

The following cut represents the cure. 

Several cases have been placed under my care in 
which the irregularity was confined to one of the 
front teeth in the upper jaw. This variety has 
hitherto proved exceedingly difficult and tedious 
to the dental practitioner. It most generally arises 



48 MECHANICAL TREATMENT OF IRREGULARITIES 




from a too crowded state of the second denture, 
the tooth being developed in an oblique direc- 
tion, the cutting edge forming almost a direct angle 
with the dental arch. This peculiarity invariably 
causes a disagreeable protrusion of the lip, render- 
ing it liable to laceration and contusion. I 
have succeeded in effecting a permanent cure of 
it by the use of the annexed instrument, which was 



OF THE SECOND TEETH. 



49 



first suggested by Mr. Brewster and employed by 
Mr. Saunders in this country. The mode of treat- 
ment by means of the instrument here represented, 
is as follows. 

To the palate and gum is accurately fitted a gold 
plate, extending as far as the first bicuspid tooth on 
either side. To sustain the plate in this position, 
holes are made in it, and ligatures of dentist's twist 
passed through them, and secured round the neck of 
each first bicuspid tooth. By this means a fixed point 
is obtained, from which the requisite traction can be 
constantly made to act in any direction on the irre- 
gular tooth. 

The method by which a continued traction is 
effected, is simply by attaching one end of a piece of 
lightly-coiled gold wire, in the shape of a spiral 
spring, to some point near the posterior margin of 
the plate, the wire being put into a state of tension 
by a silk ligature fastened to the irregular tooth. 

The spring is connected to the plate by screwing it 
on to a piece of wire bent at right angles, and sol- 
dered into the plate at such a point as will give the 
desired traction. As from time to time the tooth is 
drawn inwards, and the traction of the spring dimin- 
ished, one or more of the coils may be removed, 

D 



50 MECHANICAL TREATMENT OF IRREGULARITIES 

until the irregular tooth has been brought into the 
normal position. 

In those cases where both the front teeth are 
affected with this kind of irregularity, the operator 
should only turn one at a time ; allowing a sufficient 
period to elapse to permit the first to become tight 
in its socket, before attempting to reduce the other. 

Cases frequently occur in which the two upper 
centrals are developed so far back in the dental arch, 
that the under teeth came in front of them every 
time the jaws are closed. 

In its earlier stages this malposition may be easily 
corrected, but when it is left until the growth of the 
teeth is complete, it can never be remedied without 
the aid of mechanical means to bring the misplaced 
teeth into their proper and regular position. 

To effect this, a plate of gold is accurately fitted 
to the lower teeth, on their external and internal 
surfaces and edges. To the upper margin of this, 
another portion of the same material is soldered, 
constituting an inclined plane, prolonged so far into 
the mouth, that when the lower jaw is thrown for- 
ward, it shall still extend behind the deformed teeth; 
as here represented in the following engraving. 

It is clear then, that by this mechanical arrange- 



OF THE SECOND TEETH. 



51 




ment, when strictly adhered to, every closure of the 
month mnst exert a constant and steady pressure 
upon the irregular teeth, until the deformity is 
counteracted by bringing them over those of the 
lower jaw. In those cases where the four front teeth 
in the upper jaw close behind those of the lower, the 
apparatus should be so constructed as to extend to 
the first molar tooth on each side, over the grinding 
surfaces of which it should be carried in the form of 
caps, which will not only prevent the usual approxi- 
mation of the two jaws, but act as a security against 
the displacement of the apparatus in closing the 
mouth. To the plate opposite each irregular tooth is 
soldered the piece of gold constituting the inclined 
plane, as given in the above diagram. 

There is another plan, similar to that first men- 

d 2 



52 MECHANICAL TREATMENT OF IRREGULARITIES 

tioned (pp. 43, 44), which I have adopted most suc- 
cessfully in cases where the two laterals only in the 
upper jaw are within the dental arch; the dentine 
being secured by ligatures of dentist's twist to the 
adjoining teeth. As the teeth are brought outwards, 
the difference of space is made up by drilling holes 
opposite the irregular teeth, and inserting pieces of 
compressed hickory every two or three days, so as 
to continue the pressure until the cure is effected. 




It is however necessary in all these cases to cap one 
or more of the back teeth, to prevent the jaws from 
coming in contact. 



OF THE SECOND TEETH. 



53 



Sometimes it happens that the two front teeth in 
the upper jaw present themselves in a transverse 
position, as above represented. To remedy this un- 
sightly deformity, a plate of gold is constructed, and 
attached to the first bicuspid tooth on each side, 
and being prolonged against the internal angles of 
the irregular teeth, forms a direct point from which 
the necessary counter-pressure may be exerted. This 
must be managed as follows. A hole being drilled 
through the plate opposite to the division between 
the central teeth, a ligature is passed through it, and 
tied to an elastic gold bar placed on their anterior 
surfaces ; extending, if necessary, on both sides for 
rather more than the width of the teeth : the ligature 
being renewed as often as it is necessary. 

In less complicated cases of the same kind, bars of 
gold may be so arranged as to exert pressure on the 
internal and external surfaces of the irregular teeth ; 
the bars being firmly brought together by a ligature 
passing between them ; but to prevent the internal 
bar from slipping, it is necessary to solder a small 
piece of gold to it at right angles, extending with 
a slight curve; from which is fastened a ligature 
around the neck of each tooth. By this means the 
bars cannot fail to be retained in their proper 
position. 



54 MECHANICAL TREATMENT OF IRREGULARITIES 

This deformity may also be remedied in another 
way, which is represented in the above engraving. 
A plate of gold is adapted to the irregular teeth, and 
united to an elastic bar in such a manner, that when 
the free end of the bar is unfixed, it will spring into 
the position indicated by the dotted line. Thus con- 
stituting an elastic lever, the bar is to be fastened by 
strong ligatures of dentist's twist to one or more of 
the molar or bicuspid teeth ; by which means not 
only can one irregular tooth on that side of the 
mouth be brought gradually into its proper position, 
but, if necessary, two, three, or even four can be 
reduced at the same time. 

If it be required in similar cases to alter the rela- 
tive position of the tooth, the use of the spiral 
spring may be sometimes advantageously substituted 
for the above plan. 

In other cases, as when the two central incisors 
of the lower jaw have been developed outside the 
dental circle, and when the corresponding teeth at 
the top close behind them, I have successfully em- 
ployed the apparatus represented in the following 
cut. 

The spiral spring may be employed with perfect 
success in all similar cases, either in the upper or 
lower jaw, by substituting a flat or circular spiral 



OF THE SECOND TEETH. 55 




spring for the bar; in which case each end of the 
spring is fastened to a piece of wire, bent at right 
angles, and soldered to the outside of the plate on 
each side of the mouth. As the teeth are pressed in, 
the length of the spring must be reduced, until the 
irregular teeth are brought behind those of the 
other jaw. 

It is impossible to give all the varieties of mal- 
position that occur in practice, or to describe the 
mechanical means by which reduction is to be effected 
in every case. We have therefore mentioned those 
cases that are most frequent ; leaving it to the inge- 
nuity and inventive genius of the practical dentist 
to vary- his arrangements according to the circum- 
stances of each individual case : and we shall only 
remark in conclusion, that we have seldom seen a case 
that was entirely unmanageable by mechanical means, 



56 MECHANICAL TREATMENT OF IRREGULARITIES. 

provided time could be allowed for the treatment. 
It must however be remembered, that the length of 
the time will depend, not only upon the extent of 
the deformity and the difficulty of the case, but also 
upon the period that has been suffered to elapse 
before the treatment was commenced. 



CHAPTER V, 



PREVENTION OF IRREGULARITIES OF THE TEETH. 

The preservation of the first teeth is so essential 
to the proper development and arrangement of the 
second, that in no instance ought the former to 
be removed without the advice of a dentist, under 
whose care the child should be placed at six years 
of age. The following rules will be of use in ex- 
amining the mouth with a view to prevent irre- 
gularities. 

The arch of the jaw should be well developed \ its 
angles should present a semi-circular form ; the front 
temporary teeth, which originally were crowded, being 
somewhat separated from each other, so as to indi- 
cate a gradual expansion of the jaw ; the first per- 
manent molar teeth should be well formed, of mode- 
rate size, without any prominence of the gum behind 
the temporary teeth to shew the advance of the 
permanent. If the teeth of a child resemble those 
of one of his parents, the arch of whose jaw is 
broad and well defined, and whose teeth are of a 
regular character, the circumstance may be consi- 

d 3 



58 PREVENTION OF IRREGULARITIES 

dered auspicious of the development of a regular 
set of permanent teeth, and the practitioner may 
give a favourable prognosis accordingly. At the 
same time he should point out the danger of a pre- 
mature removal of the deciduous teeth, before the 
second are sufficiently advanced to take their places ; 
and should urge the necessity of the greatest atten- 
tion to cleanliness. 

There are some cases, however, in which the assist- 
ance of a dentist is peremptorily demanded, and 
where the future appearance of the patient will de- 
pend on his skill and judgment. 

It occasionally happens that the permanent central 
teeth of the lower jaw pierce the gum behind the 
temporary ones, and before a corresponding absorp- 
tion of these has taken place. 

In these cases it will be necessary to remove the 
deciduous teeth in front; or should there not then 
be room, one or both of the lateral teeth : but this 
operation should, if possible, be delayed till it is 
seen whether the gradual and natural expansion of 
the jaw may not remedy the defect ; for the prema- 
ture removal of the laterals takes away the natural 
support of the permanent centrals, and an unsightly 
separation is frequently caused, which it requires 
considerable ingenuity to rectify. 



OF THE TEETH. 



59 



The two front teeth in each jaw occasionally 
overlap each other, either from a too crowded state 
of the teeth themselves, or from a want of expansion 
of the jaws : in this case the removal of the two 
lateral incisors on each side is necessary to give space 
for the permanent front teeth to come forward. 

Occasionally the lateral teeth themselves, or those 
on each side the two front teeth, lap over the latter : 
in such cases the deciduous canine teeth should 
be extracted. But if it appears probable that the 
jaw will expand, which can only be ascertained by 
an examination of its arch, then these teeth should 
not be rempved till a later period, as they tend to 
preserve the shape of the arch itself. 

Irregularities are, however, more frequently met 
with in the cuspidates, which are the last teeth to 
make their appearance in the front of the jaw ; and 
to these irregularities I would particularly direct 
attention, as on the preservation and proper develop- 
ment of the cuspidates, the beauty and contour of 
the face materially depend. The cuspidate, canine 
or eye-teeth are the key-stones of the dental arch ; 
remove them, and you have an imperfect, unsafe 
and distorted structure. 

The cuspidates, as we before observed, are the last 
to make their appearance in the front of the mouth, 



60 PREVENTION OF IRREGULARITIES 

and when the others are formed and arranged, lie 
imbedded high up in the jaw, where they can easily 
be felt by means of a protuberance on the sides of 
the gum. 

It sometimes happens that the bicuspides are pro- 
duced at the side of the laterals, leaving no room 
for the canines or eye-teeth. In these cases we must 
not wait till the cuspidates are fully developed, and 
project over the others, but at once remove the first 
bicuspis on either side. The canines themselves 
should hardly ever be removed ; though in some few 
cases it may be absolutely necessary to extract the 
two lateral incisors, but not without being satisfied 
that the adjustment of the canines would be other- 
wise impossible. There is, however, one exception to 
the rule in reference to the removal of the canines ; 
and that is, when the teeth have been allowed to 
remain till they are fixed in a malposition, and pro- 
ject at right angles with the nose. But these cases 
are rare. Nothing, in fine, can justify the practice 
of removing the eye-teeth, and thus destroying the 
beauty and contour of the face, but the most impe- 
rative necessity. 

The next kind of irregularity is in the bicuspides, 
at the sides of the mouth ; this is produced by want 
of room, the bicuspides being found to project either 



OF THE TEETH. 



61 



inwards or outwards from their natural position. To 
remedy these cases, it is necessary to remove the 
deciduous molares; and then, should not sufficient 
room be given, the first permanent molar teeth also, 
if they be decayed ; if not, the second bicuspides : 
by either of which plans sufficient space will be made 
for the first bicuspid teeth to take up their proper 
stations. 

It must be kept in mind, however, that it is better 
to sacrifice the second bicuspis than a sound perma- 
nent molar. 

The following cut exhibits the bicuspid teeth at the 
time, and in the position, of which we are speaking. 




There are occasionally other malpositions of the 
teeth, but they occur so seldom, that it is unneces- 
sary to describe them ; they all require the skill of 
the dentist to remedy them, and in the treatment of 



62 PREVENTION OF IRREGULARITIES OF THE TEETH. 



all he must bear in mind, that lesser evils are to be 
preferred to greater, that nature can only be con- 
quered by submission, and that the laws of the 
animal economy are to be consulted and obeyed, but 
not subverted. 



CHAPTER VI. 



NEW INSTRUMENTS FOR EXPANDING THE ANGLES 
OF THE JAWS. 

On a reference to the causes of irregularity, it will 
be seen that one of the greatest of them consists 
in the non-expansion of the angles of the jaws suffi- 
ciently to admit the increased size of the second 
teeth. From this circumstance it frequently happens, 
that in a deep excavated palate, two, three, or even 
four of the second teeth are sacrificed by the practi- 
tioner, in order to allow the remainder to assume 
anything like a regular position. Yet such inter- 
ference with nature should never be resorted to 
without the greatest necessity ; since it is frequently 
attended with disastrous results ; the teeth permitted 
to remain not only losing in a measure their natural 
support, but in some cases being rendered inadequate 
to perform the duties for which they were intended. 

It is remarkable, on this subject, that the dental 
practitioner has not hitherto given his attention to 
one of the most important points of mechanico- 
surgical dentism. Those who have investigated the 



64 NEW INSTRUMENTS FOR EXPANDING 

art theoretically, are numerous; nor have others 
been wanting, to frame hypotheses concerning the 
structure of the teeth, and the causes of caries : 
but while theories and speculations have thus fur- 
nished matter for argument, practical dentism has 
been left to shift for itself ; and dentists, content with 
proving themselves clever theorists, have too much 
neglected real questions and improvements. This 
has been the case in every branch of the art, but 
more particularly in the one under consideration. 

The annexed wood-cuts represent two instruments 
by which we have been enabled to make the contour 
of the teeth perfect, in some instances without sacri- 
ficing a single permanent tooth, in most cases, by 
the sacrifice of one only on each side. The first 
cut shews the upper jaw, with a plate adapted to the 




curvature of the palate, in the centre of which plate 
is a hinge ; on each side are eyelets with points, to 



THE ANGLES OF THE JAWS. 



65 



which are attached iveak spiral springs, their strength 
being increased or diminished as the angles of the 
jaw expand. The second cut represents the lower 




jaw, and its action is similar to the former, but the 
construction is different, inasmuch as the springs em- 
ployed are flat, and the back teeth are capped. The 
best time for the employment of these instruments is 
from the ninth to the twelfth year ; but they may be 
used also with great, if not equal advantage, until 
the sixteenth or seventeenth year. In the former 
interval, however, when the whole frame is under- 
going the expansive process, nature more decidedly 
assists our mechanical means, and the effect produced 
is greater. 

The representation of the instruments shews at 
once their purpose and mode of application ; but 
cases will occur in which a modification and exten- 
sion of the same principles will be necessary, and 



66 IMMOBILITY OF THE LOWER JAW. 

which must of necessity be left to the judgment 
of the practical dentist. 



IMMOBILITY OF THE LOWER JAW. 

It occasionally happens, that either from the cut- 
ting of the wisdom teeth, from the use of mercury, 
from hydrophobia, or some other cause, the jaw 
becomes fixed and immoveable, constituting tetanus 
or locked jaw; which may exist to such an extent, 
that it is impossible to administer either medicine 
or nutriment excepting through an aperture made by 
extracting two or more of the front teeth. Now 
although in certain cases little hope can be enter- 
tained of recovery, yet there are other cases in which, 
though a complete fixture of the jaw is presented, 
relief may be obtained by the use of the following 
instrument, by means of which the mouth may be 
opened to a sufficient extent to admit the taking of 
solid food, until the complaint itself can be effectually 
relieved. 

This instrument acts on the principle of a screw 
and lever, and is formed by adapting two small 
plates of steel to the common tourniquet divested of 
its band. These being passed through the apertures 



IMMOBILITY OF THE LOWER JAW. 67 

in the lower part of the torniquet, their superior 
recurved extremities resting under the rollers of the 
bridge, and the other ends being brought into con- 
tact by a gentle curvature, it is only necessary to 
turn the screw in order to separate these latter to the 
required extent, which may be done very gradually. 




A glance at the accompanying figure, which repre- 
sents the plates slightly separated, will render this 
description perfectly intelligible. 



CHAPTER VII. 



THE COLOUR OF THE TEETH A TEST OF 
CONSUMPTION, ETC. 

During the growth of the teeth, important changes 
take place in their form and character. When per- 
fected, they will generally be found to resemble those 
of the parent to whom the child is most like in other 
respects ; and this, not only in size and arrangement, 
but in colour, density, and tendency to resist, or 
give way before, the ravages of decay. There are 
family likenesses in teeth as well as in face and 
person ; and we not only frequently meet with fami- 
lies in which early and premature decay of these 
organs seems to be hereditary, but with others 
whose teeth appear to set time at defiance. 

It is a well-established fact that consumption, scro- 
fula, and many other diseases, are also hereditary ; 
and that although they frequently lie dormant for 
generations, so as to lull all suspicion on the subject, 
the action of some exciting cause reproduces them, 
and a formidable disease suddenly makes its appear- 
ance. This may occur at any period of life, but does 



THE COLOUR OF THE TEETH, ETC. 69 

so more frequently between the ages of fourteen and 
twenty-five; when it often happens that the com- 
plaint (I speak more particularly of consumption) 
has made fatal progress, before serious attention is 
called to it, or measures are taken to arrest its pro- 
gress. The probability is, that were the predisposi- 
tion known, a greater degree of care and watchful- 
ness would be employed, the disease earlier detected, 
and remedial measures applied under far more fa- 
vourable auspices. 

This subject, then, The colour of the teeth as a 
test of consumptive habit and scrofulous tendency, is 
certainly one of importance, although from its novelty 
it may at first sight appear hypothetical. 

It is a well ascertained fact, that certain peculiari- 
ties in the chemical structure of the bones are in 
some cases hereditary ; that whole families are found 
that have a predisposition to mollities ossium, or 
softening of the bones, from a deficiency of their 
earthy base; while in other families the bones are 
preternaturally brittle from a superabundance of the 
same principle. And when we consider the nature 
of the teeth, and the time and manner of their for- 
mation, it is more than probable (reasoning from 
analogy), that they too are subject to a variety of in- 
fluences, not only as regards their shape and posi- 



70 



THE COLOUR OF THE TEETH 



tion, but as regards their chemical structure; and 
that hence they may serve as valuable criteria, both 
of an unnatural state of the humors, and of certain 
constitutional tendencies and predispositions. 

In animals that are not subject to the influence of 
sophistication or disease, there is little variety in the 
appearance of the teeth ; those of animals of the 
same class (making allowance for age) being of the 
same strength and density. In human beings, on 
the contrary, the case is different ; and as the secre- 
tions of the body vary with circumstances, health and 
diet, so we have every variety not only in the form 
and position, but also in the density and colour of 
the dental organs. The natural deduction from this 
is, since the phthisical diathesis produces uniform 
results on the secretions of the body, and transmits 
certain peculiarities to the progeny of its unfortu- 
nate possessors, that it will act in the same uniform 
manner on the teeth, which may thus become valu- 
able indications of disease. And this applies not 
only to consumption, but to many other hereditary 
complaints. If the subject be scientifically pursued, 
and medical men give the benefit of their knowledge 
and experience to further this important aid to diag- 
nosis, the time may come when the above indications 
will point out danger in time to avert it, and many 



A TEST OF CONSUMPTION, ETC. 71 

cases of phthisis pulmonalis that would at present 
be considered incurable, will be brought within the 
pale of successful treatment. Moreover, as no im- 
portant inquiry can be carried on without producing 
contingent benefits, the collateral advantages to me- 
dical science will probably be great. 

And here I think it right to state, that my opi- 
nions on this subject, although new to the world, are 
founded on close observation, and on the incontro- 
vertible facts supplied by an extensive practice. 
Others whose attention is now first called to the 
point will no doubt have ample opportunities of test- 
ing its truth by their own experience. 

It has been observed by most authors who have 
written on the teeth, but more particularly by Dr. C. 
Harris, of Baltimore, that the teeth of consumptive 
and scrofulous persons have either a beautiful crys- 
talline appearance, and are of a whiteness almost re- 
sembling alabaster, or of a clear pearly character, 
with the enamel slightly tinged with blue, or fre- 
quently of a very pale yellow or orange colour; 
particularly in the early stages of the disease. As 
the disease advances, the colour of the teeth is 
changed, and the osseous structure becomes softer 
and darker, approaching a deep yellow. Still later 
on again, when death is at hand, the structure of 



72 



THE COLOUR OP THE TEETH 



the teeth is affected in proportion both in colour and 
density. In those cases where I have had opportu- 
nities of examining teeth recently extracted from 
the mouth of a person who has died of consump- 
tion, and have made sections of them, I have found 
them peculiarly characteristic of the disease, and 
contradistinguished from those of persons who have 
died of other diseases ; inasmuch as a complete soft- 
ening has taken place, the bone resembling decayed 
sponge in texture, and being of a darkish orange- 
colour; while in non-consumptive teeth the bone 
was of a lightish grey, without any change having 
taken place in density of structure. Observations, 
however, have not hitherto been made till the dis- 
ease was confirmed, and the patient beyond hope of 
recovery; although we are well persuaded that the 
dental symptoms may be used as means of detecting 
the latent seeds of consumption or scrofula.* 

* " The teeth furnish very considerable characteristics of scrofulous 
habits : either they are badly formed as to their common outline ; 
their surfaces are corrugated and discoloured ; or, if they be well 
shap en individually, their enamel is very thin and preternaturally white, 
and the spaces between the teeth are unusually wide. It is wise to 
observe the teeth of nurses ; for I should always question the fitness 
of a wet-nurse with a bad set of teeth, however other circumstances 
may be in her favour." (View of the. Alimentary Organs, by Thomas 
Hare; page 228. London, 1821.) 



A TEST OF CONSUMPTION, ETC. 73 

In all cases in which I have observed the above 
indications in the teeth of children, (transmitting 
light through them to ensure accuracy,) I have found 
on enquiry that either consumption or scrofula has 
existed, though perhaps generations back, in the 
family of one or other of the parents of such chil- 
dren ; and this it was that first led me to consider, 
that certain appearances in the teeth might become 
availably diagnostic of the above dangerous com- 
plaints. Since then, my first conceptions have too 
often been realized by these very diseases shewing 
themselves in the suspected cases, sometimes owing 
to the action of an exciting cause ;* sometimes where 
no cause was assignable ; for we all know that con- 
sumption frequently appears as a genuine idiopathic 
malady. 

It has been well remarked by Delabarre, when 
speaking of the physical characteristics of the teeth, 

* " Let it be supposed, for instance, that the lungs are a child's 
weak part, and that, under ordinary circumstances, he would have a 
coUgh during dentition ; let him be exposed to cold whilst cutting his 
teeth, and not only will he be more disposed to take cold at such 
time, but the fever will be much more likely to put on the form of 
inflammation of the lungs than under ordinary circumstances. Here 
then dentition acts as a violent predisposing cause of disease." (Hayden 
on Diseases of Children, p. 47. London, 1819.) 

E 



74 THE COLOUR OF THE TEETH 

that medical practitioners may derive useful hints 
from this source to enable them to point out the 
rules of domestic hygiene for children. " Can the 
physician/' says Delabarre, " admit of but one mode 
[of diagnosis] ? Has he not, then, the greatest in- 
terest to be well assured of the innate constitution of 
each patient for whom his advice is required, to enable 
him to recommend nutriment suited to the strength 
of the organs ? Will he report only on a superficial 
examination of the face, its paleness, the colour of the 
skin, all of which are variable ? Will he not regard 
the repletion, or leanness of the subject, the state of 
the pulse, &c. ? Surely he will make good inductions 
from all these things; but the minute examination 
of the mouth will give him, beyond doubt, the 
means of confirming his judgment; for, besides 
what we already know of the teeth, the mucous 
membrane of this cavity receives its colour from the 
blood, and varies according to the state of that 
fluid/' 

Such are the opinions of one of the best dental 
pathologists in Europe, and they serve to confirm 
the view, that the appearances of the teeth may 
furnish data for determining the state of the body 
generally ; and if so, it is not unreasonable to sup- 
pose, (what indeed is proved by fact,) that in the 



A TEST OF CONSUMPTION^ ETC. 75 

same organs we may read the signs of consumption 
and scrofula, long before they have assumed their 
denned characters, and become established diseases, 
incurable by physic. 

We would therefore impress on the minds of 
parents, the duty, in suspected cases, of submitting 
the teeth of their children, at from seven to ten 
years of age, to the examination of a dentist; so 
that if the teeth display the abnormal colour and 
signs we have described, no time may be lost in 
taking medical advice while yet available ; in short, 
while attention to climate, temperature and diet may 
accomplish for the health, what at a later period 
medicine itself would be powerless to attain. 

It is remarkable that the colour of the decayed 
parts of the teeth in persons of consumptive habit, 
differs considerably from the colour in common 
caries.* Thus in some cases there is a complete and 

* " The colour of dental caries, however, may be, and doubtless 
is, in some cases, influenced by other circumstances ; but as to what 
these are, I profess myself ignorant. They may consist in some 
peculiar modification of the agents, upon the chemical action of which 
on the organs, the disease is dependent; but this is mere conjecture, 
and the solution of the question still remains for future investigation." 
(Dr. C. Harris, On the Characteristics of the Teeth and Gums, 
page 50. 1845.) 

E 2 



76 THE COLOUR OF THE TEETH 

peculiar softening of the bone, extending beyond the 
diseased part, and accompanied more or less by a pale 
orange or yellow colour ; but which softening does not 
arise, as is sometimes thought, from the acrid quali- 
ties of the saliva, acting chemically upon the calca- 
reous portion of the tooth, and leaving only the 
gelatinous substance : for in these cases analysis gives 
the same proportion of earthy salts and gelatinous 
substance, as in a tooth decaying under any other 
disease, in which acrid qualities are not present in 
the secretions of the mouth. In other cases again 
we have the calcareous deposit (tartar) coloured in a 
peculiar manner in this disease.* 

As we before observed, the precautionary exami- 
nation of the teeth should not be neglected be- 
tween the seventh and tenth years. For during 
this interval, the second set is so far complete, that 
its physical character may be clearly ascertained. 
Enough however has been said, to shew that the 
knowledge thus acquired is of great importance, 
independently of mechanical considerations, from the 

* " The colour, consistence and quantity of salivary calculus or 
tartar as it is most commonly called, vary in different temperaments, 
and . . . the state of the general health exercises a considerable influ- 
ence [upon them]. They therefore furnish diagnostics, important 
both to the physician and dental surgeon." (Ibid., page 87.) 



A TEST OF CONSUMPTION, ETC. 77 

light which it affords respecting the health of the 
whole system. 

In concluding this subject we may fairly remark, 
that when we claim for the teeth a considerable rank 
among what may be called diagnostic organs, we by 
no means are without analogies in what has been 
already established by the consent of the medical 
world. Thus in many respects the nails and the 
hair are similar to the teeth, as possessing a low 
degree of vitality, and as being seated external to the 
skin or common membrane. And it is well known 
that the nails have long furnished marks by which 
consumptive tendencies are recognized ; and that the 
hair, to say the least, is peculiarly representative of 
the state of the body, and varies in its condition as 
the latter varies. Moreover, the teeth are situated 
in the mouth, in which extreme cavity, all the parts 
being naked, and the blood shewing itself as respects 
quantity and colour through the thin windows of the 
mucous surface, nearly every organ becomes indica- 
tive of the state of the system. Thus the lips, by 
their colour, moisture, &c, plainly represent the ge- 
neral health and vigour. The tongue, by an innu- 
merable multitude of signs, does the same. And as 
if the whole of this oral region concurred to utter 
forth what is concealed in other parts of the body, 



78 DO THE TEETH INDICATE THE AGE? 

the voice itself is one of the great characteristics of 
strength or weakness, health or disease. Thus in 
adding the teeth to the other organs of the mouth as 
representatives of general physical conditions — in 
thus adding them from experience and observation — 
we do what might have been expected even previous 
to the induction from which we profess to derive all 
our knowledge. 

The annexed drawings represent the different 
colours and stages attending disease of the teeth, in a 
person of consumptive and scrofulous habit. A, the 
predisposition; B, the first stage; C, the second; 
D, the third and last ; F, the internal structure after 
death ; E, after death from some other cause. 



DO THE TEETH INDICATE THE AGE ? 

This question for some time engaged the attention 
of Mr. Saunders, who inspected the mouths of 1046 
children, to ascertain whether any appearances fur- 
nished by the teeth are sufficient to guide us to a 
sure knowledge of the age of the individual. He 
was examined on the subject before a Committee of 
the House of Commons on Lord Ashley's " Factory 
Bill/' and the result of his enquiries is given in a 




THE COLOR OF THE TEETH THE TEST OF CONSUMPTION 

> /,, MM ifpkrt lifti. Printers. 



DO THE TEETH INDICATE THE AGE ? 79 

work by Mr. Charles "Wing, entitled, The Factory 
System. 

Whether the elaborate statistics in this work are 
considered satisfactory by the philanthropic persons 
interested in factory labour, I do not know ; but for 
myself, I confess that the above point is anything but 
proved in the affirmative. The development of the 
teeth depends upon a variety of circumstances, — 
upon the constitution, habits, mode of living, and 
general health. This at once makes us sceptical of 
our ability to deduce from them any invariable con- 
clusions respecting the age of their possessor; and 
the endless variety of cases which are met with in 
public and private practice tend to confirm us in 
disbelief on this subject. 

Mr. Saunders, it is true, takes the other side of 
the case, being led thereto by comparing the deve- 
lopment of the human teeth with that of the teeth 
of animals ; but he seems to forget that brute ani- 
mals live in a comparatively natural state, and that 
consequently their organizations are subject to more 
fixed rules than the human frame, acted upon, as it 
is, by a variety of influences (whether arising from 
social conditions, from the mind, or from the exter- 
nal universe,) which largely interfere with its organic 
and physical evolution. 



80 DO THE TEETH INDICATE THE AGE? 

Thus the age of the horse, up to a certain period, 
is inferred from certain marks on the teeth, and 
when these marks are obliterated, or as it is techni- 
cally called, filled up, the animal is said to be aged-, 
after which the age can no longer be correctly guessed 
by reference to the teeth. 

To illustrate this, we will now describe the ana- 
tomical characters of the horse's tooth. A longi- 
tudinal section of an incisor before it has been worn 
down by use, is represented below. It will here be 




seen that the cutting edge is bifurcate, presenting 
an anterior and posterior wall. These walls are sepa- 
rated by a deep fissure, which is lined and partially 
filled with cementum that extends into the tooth 
about an inch, or in some cases more ; the dentine or 
osseous portion maintaining throughout a uniform 
appearance. Now until the tooth is so far worn as 
to obliterate this mark constituted by the interposi- 
tion of the cementum, the age of the horse may be 
inferred from the teeth, but afterwards this is not 
the case, as we said above. 



DO THE TEETH INDICATE THE AGE? 81 

The mark disappears from the horse's teeth in the 
order of their original formation; first therefore 
from the centrals, then from the laterals, and lastly 
from the posterior incisors; so that in the seventh 
year there is a palpable difference in the appearance 
of the different teeth ; the mark being obliterated in 
some, and still remaining in others. 




This mark is occasionally simulated for the purpose 
of deception, by cauterizing the centre of the sur- 
face of the tooth; but whoever knows that where 
the mark is natural, the enamel lining it may always 
be felt, will not easily be imposed upon by this 
I artifice. 

The form and position of the tush, or remains of 

e 3 



82 DO THE TEETH INDICATE THE AGE? 

the cuspid tooth, are also used as collateral evidences 
of age in horses. This tooth is originally conical, 
but in a great measure ceases to be so as it is worn 
down. The conical shape is sometimes restored by 
filing, but the difference between the natural and 
artificial cone may be detected by feeling for the 
slight longitudinal concavity on its inner surface. 
Moreover, the approximation of the tushes to the 
front teeth, from which they are at first separated by 
a considerable interval, is regarded by judges as a 
good test of age. 

But nevertheless it so happens, that the above 
marks are not absolute indications even in the horse 
among the lower animals, which live in a state so 
nearly bordering on the state of nature. How much 
less, then, can the teeth be depended upon as tests of 
age in human beings, subject as they are, as we be- 
fore observed, to such immense vicissitudes, physical, 
social, and mental. It is not, however, our inten- 
tion to deny, that certain loose general inferences on 
the subject of age may be obtained from the teeth, 
and consequently that these organs may furnish 
probable and supplementary indications on an ave- 
rage of numerous instances; but still we do not 
admit the validity of these indications in particular 



DO THE TEETH INDICATE THE AGE? 83 

cases ; and as practical knowledge applies to parti- 
culars, we should be sorry to see judicial arguments 
founded upon so insecure a foundation as the view 
that the teeth proclaim the age of the individual. 



CHAPTER VIII. 



THE CAUSE OF CARIES. 

This affection of the teeth, which causes their pre- 
mature destruction, and is attended at times with 
considerable pain, is not confined to any age or to 
either sex. It generally indeed attacks the young, 
and is rarely met with past the age of sixty, but this 
is by no means an invariable rule. 

The opinions on the cause of this disease are 
almost as numerous as the authors who have treated 
of it; though rich as we consequently are in such 
opinions, the real question is as much a matter of 
doubt as when Hunter first promulgated his senti- 
ments on the subject. For the reader's edification, 
or amusement, we shall prove these assertions out of 
the mouths of the most eminent of those who have 
favoured the world with their views. 

" Who shall decide when doctors disagree ?" 

Hunter (1778) says : " This decay does not seem to 
be so entirely the effect of accident as might be ima- 
gined : it sometimes takes place in the teeth in pairs, 



THE CAUSE OF CARIES. 



85 



in which case we may suppose it owing to an original 
cause, coming into action at its stated time, — the 
corresponding teeth being in pairs with respect to 
the disease, as well as to situation, shape, &c." 

He further says : " This disease has not hitherto 
been accounted for : if it had been always on the 
inside of the cavity, it might have been supposed to 
be owing to a deficiency of nourishment, from some 
fault in the vascular system ; but as it begins most 
commonly externally, in a part where the teeth, in 
their most sound state, receive little or no nourish- 
ment, we cannot refer it to that cause ; we may 
therefore reasonably suppose that it is a disease 
arising originally in the tooth itself." 

Ruspini (1784) : "Various are the species of caries; 
almost every part of the teeth is affected by it, and 
both internal and external causes produce it. A 
caries may be divided into soft, superficial, deep, 
and dry : it attacks the root, the neck, or the crown 
of the teeth. The caries that proceeds from internal 
causes, namely, the scurvy, &c, generally affects the 
root of the tooth, often the internal surface, some- 
times the external, and even the inward cavity of the 
body [of the tooth] 

Gerbeaux, of Paris (1802), says "that diseases of 
the teeth among many individuals originate in or- 



86 



THE CAUSE OF CARIES. 



ganic disposition, which may be transmitted from 
fathers to their children." 

According to Fox (1813), "The proximate cause 
of caries appears to be, an inflammation in the bone 
of the crown of the tooth, which, on account of its 
peculiar structure, terminates in mortification. The 
chief predisposition to this disease, consists in a de- 
fective formation, of either the enamel or bony part 
of the teeth. . . . 

" It is not in our power to alter the laws of nature, 
or change the natural constitution of man ; we can 
only obviate evils, by attending to the causes which 
produce them ; and it is in this manner we can, in a 
very great measure, preserve the teeth from disease." 

Hertz (1815) observes: "Heat, to a certain de- 
gree, is highly detrimental to the vitality of the 
teeth ; hence we find that those animals, who live 
chiefly on hot food, are most subject to carious 
teeth. Increased circulation in the gums, whether 
the effect of mercury, or general fever of the system, 
is also very injurious to the teeth, and hence caries 
of the teeth is a common consequence of salivation 
and inflammatory fever." 

Bew (1819) : " To those who only casually glance 
at the teeth primary or permanent, with healthy 
gums, fitly arranged in their several sockets for the 



THE CAUSE OF CARIES. 



87 



purposes of mastication, aided by the conviction of 
sight and feeling, that they are the hardest sub- 
stance in our system, how inexplicable and irrecon- 
cilable to credibility must it appear, that these very 
hard substances, with their flinty coatings, date their 
destruction from completion, by lateral pressure 
against each other" 

Parmly (1820) : "The premature decay of the 
teeth, is the consequence of uncleanliness, which 
acts upon them in the same manner as on other 
parts, by sapping and corroding the vital energy, 
and thereby causing them to moulder away." 

Clarke (1829) says, that " caries or rottenness of the 
teeth, in every instance, commences externally, and 
that external remedies will arrest, if not prevent, it 
altogether. . . . When indentation or such like ine- 
quality occurs on the surfaces of the teeth, the juices 
of the mouth then become stagnant ; their properties 
change, and they exert a pernicious influence, aided 
by the putrefying particles of animal and vegetable 
substances which likewise necessarily lodge there." 

Bell, in 1835, states, that the true proximate cause 
of dental gangrene [caries] is inflammation, which 
appears, according to him, to take place in the fol- 
lowing manner : " When from cold, or from any 
other cause, a tooth becomes inflamed, the part 



88 



THE CAUSE OF CARIES. 



which suffers the most severely is unable, from its 
possessing comparatively but a small degree of vital 
power, to recover from the effects of inflammation, 
and mortification of that part is the consequence. 
The situation in which gangrene invariably makes its 
first appearance, immediately under the enamel, upon 
the surface of the bone, is, I think, explicable only 
with the view I have taken of the structure of the 
teeth and the nature of this disease. As the vessels 
and nerves which supply the bone of the teeth, are 
principally derived from the internal membrane, it 
is natural to conclude, that in so dense a structure, 
the organization would be less perfect in those parts 
which are farthest removed from its source." 

Saunders (1837) says: "That very general and 
distressing disease of the teeth which is familiarly 
known by the term caries or decay, may be referred 
to two distinct sets of causes, one of which may be 
termed constitutional or predisposing, and the other, 
developing or exciting causes. Under the former 
are included all those hereditary predispositions to 
disease which may be sometimes observed in a cer- 
tain tooth, or class of teeth, in certain members of 
a family. . . . These organs are predisposed to disease^ 
from interruptions and commotions in the system 
occurring during their formation. Of this class are 



THE CAUSE OF CARIES. 



89 



all those ailments and affections which make up the 
catalogue of infantile diseases, and which, by pro- 
ducing an irregular or vitiated condition of the secre- 
tions, interfere more or less with the proper action 
of the parts concerned in the production or forma- 
tion of the teeth. The exciting or developing causes 
of disease consist in subjecting the teeth to violent 
and unnatural action and uses, such as cracking 
nuts, biting hard substances, &c." 

Robertson (1840) : "Upon examination it will be 
found that there are fissures formed in the enamel of 
the teeth, in consequence of the irregular distribu- 
tion of that substance upon their surfaces ; and that 
there are also interstices produced by the crowded 
position of the teeth, and the irregularity of their 
shape. In these situations particles of food are re- 
tained, which undergo a process of decomposition, 
and acquire the property of corroding, disuniting, 
and thereby destroying, the earthy and animal sub- 
stance of which the teeth are composed. This is the 
cause of the destruction of the teeth, commonly 
called ' caries/ and it is not the result of inflam- 
mation either in the membrane or the bone of the 
tooth," &c. 

White (1844) : " The principal and direct cause of 
caries is the corrosive action of external agents : 



90 



THE CAUSE OF CARIES. 



among these, undoubtedly, the acid formed in the 
mouth by the decomposition of vegetable matter is 
one of the principal. In the depressions upon the 
grinding surfaces of the molar teeth the food finds a 
lodgement, and continues from day to day until the 
acid has formed and acted upon the enamel, which 
is frequently imperfect in those parts." 

Harris (1845) : " If the decay of the teeth is not 
referable to inflammation in their bony structure, to 
what is it to be ascribed ? The inference is, that it 
is the result of the action of chemical agents, and 
when we take into consideration that the fluids of 
the mouth, when in a morbid condition, are capable 
of decomposing their enamels, if not possessed of 
more than ordinary density, and that the disease 
frequently commences upon this outer covering, the 
conclusion is at once irresistible. ... As I have before 
remarked, caries is always upon their external sur- 
faces, sometimes upon the enamel, but most fre- 
quently upon the bone within the indentations on 
the grinding faces of the bicuspides and molares ; 
and on the approximal sides of the teeth, where this 
outer covering is frequently so fractured by the pres- 
sure that is exerted upon it, that the juices of the 
mouth find ready access to the subjacent osseous 
tissue. The destruction of the organs may be gra- 



THE CAUSE OF CARIES. 



91 



dually going on here for months, and even years, 
without any notable signs of its existence : and the 
commencement of the disease in these places had 
led many to suppose that it had its origin within 

their osseous structure Among the indirect 

causes, therefore, of caries, the following may be 
enumerated : — putrescent particles of vegetable or 
animal matter between the teeth ; depositions of 
tartar; a febrile or irritable state of the body; a 
mercurial diathesis of the general system ; artificial 
teeth, improperly inserted, or of bad materials ; roots 
of teeth ; irregularity in the arrangement of the 
teeth ; too great a pressure of the teeth against each 
other; and, in short, everything that is productive 
of irritation to the alveolar and dental membranes 
or gums." 

The above extracts may be considered sufficient to 
shew how little is really known of the causes of 
caries. And now, having cited the opinions of others, 
I shall perhaps be expected to register my own. 
The field of speculation, however, is well enough 
occupied without it : and moreover any view would 
be practically worthless, unless it enabled us to 
foresee the disorganization of the teeth, which we 
cannot do at present. I will nevertheless commit 
myself so far as to observe, that the nearest approach 



92 



THE CAUSE OF CARIES. 



to truth appears to me to be the chemical theory of 
ParmLy, put forth in the year 1820, and maintained 
by Dr. C. A. Harris in his last work. But even this 
theory requires completion. The labours of recent 
pathologists seem to shew, that an acid liquor is 
secreted by the glands of the gums contiguous to 
the necks of the teeth, and that it is to the agency 
of this liquor that caries is contingently due; an 
opinion the more plausible from the circumstance, 
that the lower incisor teeth, which are continually 
washed in the alkaline secretions of the mouth, are 
far less subject to caries than the upper. 

This acid secretion acquires increased strength and 
activity in those disorders that debilitate the sto- 
mach ; and hence, perhaps, it is that the teeth are 
frequently affected with caries in such cases, parti- 
cularly where the disease is of long standing, and 
has seriously impaired the digestive functions. The 
fact that carious teeth are attendants on a weak 
stomach or vitiated digestion, and are seldom met 
with where the stomach is strong and healthy, is 
well established, and may tend to confirm the che- 
mical theory. 

Nevertheless in all chemical reasonings on the 
living body, it is well to bear in mind, that where 
the system, or any part of it, is vigorous, its vita- 



THE CAUSES AND TREATMENT OF TOOTH-ACHE. 93 



my enables it to resist chemical agencies ; and that 
the measure in which the latter govern it, determines 
the departure from health and soundness. The 
greatest instance of this is seen in the difference 
between the living and the dead body. The former 
is bathed in gaseous compounds, which have a pow- 
erful tendency to act upon it ; but its life restrains 
them, and their chemical affinities are controlled. 
In the dead body, on the other hand, the surround- 
ing atmosphere, moisture, &c, at once exert their 
peculiar forces, and decomposition is the result. And 
therefore it appears to us, that chemical operations 
of the saliva upon the teeth, presuppose diminished 
vitality in those organs, otherwise such operations 
would be held in check. And for this reason it is 
that we regard even the chemical theory as less than 
half the truth on this subject of caries. 



THE CAUSES AND TREATMENT OF TOOTH- ACHE. 

Tooth-ache is a term applied indiscriminately in 
common discourse to all pains affecting the teeth and 
jaws. It may arise, however, from very different 
causes ; as from exposure of the dental nerve, from 
fungus of the pulp, from the confinement of pus in 



94 



THE CAUSES AND TREATMENT 



the internal cavity of a tooth, from disease of the 
membrane covering the fang (periosteum), from sym- 
pathy, &c, &c, &c. When a tooth is sound, its 
nerve is confined in a thick bony covering, which 
effectually shields it from injury, but often the nerve 
is exposed by disease to the action of air, fluids, food, 
or irritants of any kind, and in this event the most 
intense pain may result, proportioned to the degree 
of nervous lesion. When tooth-ache originates in 
inflammation of the internal pulp from any of the 
above causes, the pain is sharp, lanciating and throb- 
bing, and is not increased by pressure upon the part 
affected. 

Sometimes inflammation takes place in the cavity 
of the tooth, and the nerve suppurates. Pain may 
be felt for months before suppuration occurs, though 
the latter more generally commences on the first or 
second paroxysm. But invariably sooner or later the 
crown of the tooth decays, and the nerve is com- 
pletely exposed. 

Next after tooth- ache arising from exposure of the 
nerve, that which depends upon the confinement of 
pus in the dental cavity is the most frequent. In 
the commencement of these cases the pain is felt 
only when hot or cold liquid passes over the affected 
tooth, but gradually a steady gnawing pain super- 



Or TOOTH-ACHE. 



95 



venes, the tooth becomes sore and tender, seems a 
little loose and longer than the others, and pain 
darts from it along the nerves to the temple, the ear, 
the side of the head, and to the neighbouring teeth 
in both jaws. When a tooth first grows painful in 
this way, it is about to suppurate ; when it appears 
longer than the rest, loose, and exceedingly sore, 
the nerve has suppurated, and the pus is already 
oozing from the end of the fang where the vessels 
and nerves enter. When the cheek begins to swell, 
it is a sign that the matter is spreading between the 
alveolus and its lining membrane ; which occasions 
the throbbing pain felt during the formation of al- 
veolar abscess. 

It is by the same process, when the fang of a dis- 
eased tooth is near the antrum, that true abscess of 
that cavity takes place. 

Pain, however, may exist, the nerve may suppu- 
rate, and the face swell, and both the pain and 
swelling again subside, without the formation of ab- 
scess ; in which case the matter insinuates itself be- 
tween the end of the fang and its membranous 
covering, there forming a sac about the size of a pea 
or a little larger. In the course of time this sac 
will burst, and discharge its pus between the fang 
and the alveolar process. 



96 THE CAUSES AND TREATMENT 

In tooth-ache arising from inflammation and thick- 
ening of the membranous covering of the end of the 
fang, and resulting in the formation of pus, the pain is 
confined to the tooth, the nerve of which has suppu- 
rated, and produced alveolar abscess. In these cases, 
the suppuration of the nerve and the formation of 
an abscess are always primary causes of the disease. 
The pain is generally dull and heavy ; the tooth be- 
comes a little sore, and loose ; immediately over and 
all along the fang the gums are much inflamed, and 
of a bluish tinge. When the pain becomes throbbing, 
matter is in course of formation, and partial filling up 
of the alveolar process takes place, forming what is 
termed a gum-boil. In some cases of the kind, if 
allowed to proceed unchecked, part of the alveolar 
process is absorbed, and a fistulous opening forms on 
the outside of the cheek. 

Fungus of the pulp is a small tumor of a deep 
red colour, either in the canal of the fang, — in which 
case it is so minute as to be often mistaken for the 
nerve itself; or else in the cavity of the crown, 
which it generally fills when it is present there. It 
is very soft, bleeds freely on the slightest touch, and 
varies in size from a pur's head to a large pea. 
Sometimes it is quite insensitive ; in other cases ex- 
quisitely sensitive ; but the pain it occasions is not 



OF TOOTH-ACHE. 



97 



accompanied by the dartings and throbbings that 
characterize genuine affections of the nerve. No 
other disease of the mouth renders the breath so 
disagreeably offensive as the fungus of which we are 
now speaking. 

All the above kinds of tooth-ache, with the excep- 
tion of the last (sympathetic tooth-ache), are of an 
inflammatory character, and require to be treated on 
the antiphlogistic plan. Cold water is the best ap- 
plication to them; and this, if the crown of the 
tooth be affected, will generally afford immediate 
relief. On the other hand, if the inflammation be 
lower down, the cold water will at first increase the 
pain, but if persevered in, will eventually relieve it. 
Where the inflammatory action runs high, and the 
pain is very severe, it will be necessary to resort to 
more active treatment : leeches should be freely ap- 
plied to the gums, a brisk purge administered, and 
lowering regimen be strictly enforced. Should it ap- 
pear impossible to prevent suppuration, and should 
the patient object at the time to the removal of the 
tooth, warm fomentations containing a proportion of 
opium or henbane should be applied to the parts, 
and as soon as the matter has formed, the tooth 
should be at once extracted. 

The cause of the peculiar pain of tooth-ache appears 



98 



THE CAUSES AND TREATMENT 



to consist in the circumstance, that the dental vessels 
and nerves are confined in bony canals, which during 
inflammation do not admit of vascular congestion 
without producing severe compression of the nervous 
fibres. In this way we can account for the fact, that 
conditions which increase the vascular action of the 
system, are very apt to be attended with tooth-ache. 
In pregnancy, it is well known, that the blood, when 
drawn, exhibits the characteristic buffy coat of in- 
flammation ; in pregnancy, therefore, tooth-ache is a 
common affection. With respect to the cause of the 
pain, the teeth follow the same law as many other 
organs, — as the ear, the bones generally, &c, — in 
which the distress is pretty nearly proportioned to 
the unyielding nature of the parts. In this way it 
happens, that structures which are least vital or sen- 
sitive in health, become the seats of agonizing pain 
during inflammation, which tends to expand them 
violently, according to the laws of the pressure of 
fluids ; a pressure which we all know to be so great. 

The treatment of tooth-ache from exposure of the 
nerve, must be simply palliative. The essential oils, 
mineral acids, creosote, and a variety of stimulants, 
have been used, with more or less success, to benumb 
or destroy the sensibility of the part. It is not well, 
however, to apply them indiscriminately, for in some 



OF TOOTH-ACHE. 



99 



cases they do mischief. In our experience, the most 
useful applications have been the terchloride of 
carbon with morphia, or a mixture of creosote and 
morphia made into a paste with finely-powdered 
gum-mastic, and applied to the nerve on a small 
piece of lint. Chloride of zinc, tannin, and tinc- 
ture of galls, have also been employed in these 
tooth- aches, but they are less certain in their effects 
than the substances just mentioned, and therefore 
we are seldom called upon to use them. 

We are not among those who advocate what is 
denominated the radical treatment, which consists in 
crushing or cauterizing the nerve, and which some 
writers inform us is a painless or even a pleasant 
operation. On this subject we shall say nothing. 
Sooner or later nature performs a cure; the nerve 
being removed from exposure and contact by suppu- 
ration. Till this event takes place, the palliative 
treatment involves all that can be done with pru- 
dence. 

Fungus of the pulp is occasionally removed by 
lunar caustic, which, if repeatedly applied, will de- 
stroy the diseased part, while temporary relief may 
be gained by puncturing the fungus and causing it 
to bleed freely. But extraction is the only perma- 
nent cure; for so long as the tooth remains in the 

f 2 



100 THE CAUSES AND TREATMENT 

mouth, the disease generally returns, whatever may 
have been done, after the expiration of a few months. 

When pus has collected in the inner cavity of a 
tooth, when the face is swollen, and there is throb- 
bing pain, the tooth must be removed. At an early 
period, the tooth may be trepanned or drilled, and 
the matter thus discharged; a plan which may be 
successful in some cases even where pus has begun 
to ooze from the end of the fang. 

Tooth-ache arising from disease of the periosteum 
or covering of the fang, may generally be relieved 
by the application of leeches to the gum, and the 
administration of sedatives internally ; or by making 
an incision through the gum the entire length of the 
fang, and then applying a roasted fig or a bruised 
raisin. 

It remains for us to notice tooth-ache arising from 
sympathy ; an affection due to the intimate unity of 
the nervous system, all the parts of which are in 
mutual connexion with each other. 

As one instance of the kind, during the formation 
of alveolar abscess, the surrounding parts are fre- 
quently affected with pain and inflammation ; all the 
teeth suffering in turn, although but a single one is 
generally the prime seat of the disease. 

Sympathetic tooth-ache is most frequent during 



OF TOOTH-ACHE. 



101 



pregnancy, and may arise from increased or dimin- 
ished action of the general system. Sometimes it 
proceeds from a tooth already diseased, and, where 
this is the cause, it should, if possible, be at once 
removed. But care is requisite here to judge cor- 
rectly, for pain from teeth thus affected may gene- 
rally be removed by appropriate means. Moreover, 
we have known hundreds of cases in which tooth 
after tooth was removed without affording relief; and 
it was only when the teeth of the patient and the 
reputation of the practitioner were sacrificed, that 
the real cause of the disease was rightly suspected to 
be, not in the mouth, but in the general state of the 
system. 



CHAPTER IX. 



STOPPING. 

This operation, if timely resorted to, and well per- 
formed, is one of the most valuable in dental surgery. 

To secure its advantages, it ought to be under- 
taken while the decay is in the incipient stage, before 
it has penetrated so far as to affect the nerve. For 
this reason it is, that those who wish to preserve their 
teeth, should periodically visit the dentist ; for in 
some cases the progress of decay is very rapid, yet is 
only indicated by a small speck on the enamel, which 
latter the disease proceeds to undermine, till that 
substance, being robbed of its natural support, sud- 
denly gives way, and a large cavity is exposed, al- 
though the tooth was not even suspected to be in a 
state of caries. 

How often do we hear a patient remark, that he 
has had a spot on some particular tooth for years ; to 
which spot, as it is unaccompanied by pain, he 
attaches no importance, erroneously believing it to 
be a mere discolouration. Now the truth is, that 



STOPPING. 



103 



the most favourable time for stopping is at the com- 
mencement of decay, when a spot first appears on 
the surface of the enamel, or a discolouration is ob- 
served between the teeth on the external surface. 
Although, however, this is the best time for the ope- 
ration, it may be performed with every probability of 
success at a later period, even when the tooth is so 
far decayed as to expose the nerve and give consider- 
able pain. In these neglected cases, a judicious ap- 
plication of the palliative treatment before referred 
to, must be made, and the irritability of the exposed 
nerve allayed, before stopping is attempted. This 
object may be gained, even though the patient have 
suffered many paroxysms of pain, and thus the tooth 
may be rendered capable of bearing without incon- 
venience any pressure necessary in the operation. 

We can safely assert, that there are comparatively 
few cases (provided the surrounding parts be healthy) 
in which this operation may not be employed with 
advantage, and extraction thereby avoided, and the 
services of a valuable tooth secured for years. 

Extraction is frequently resorted to, not from ab- 
solute necessity, but because it is readier and shorter 
than stopping; of course we cannot commend the 
practitioners who save themselves trouble by this 
alternative. 



104 



STOPPING. 



Neither is the practice to be commended of ex- 
tracting teeth merely because they are decayed and 
painful, without reference to all the circumstances 
of the case. What should we think of a surgeon 
who amputated a diseased limb without first attempt- 
ing to cure it, and thus save it for the patient's use ? 
And what shall we think of a dentist who rushes at 
once in all cases to the extreme operation of extrac- 
tion, and removes teeth that, by judicious treatment, 
might still be serviceable in mastication, and preserve 
intact the appearance of the mouth for years ? 

We shall now describe the operation of stopping. 

Having ascertained that there is no pain in the 
tooth, and that it will bear the necessary force and 
pressure without giving pain, the cavity which we 
wish to stop is to be well cleaned out by appropriate 
cutting instruments, until every vestige of decay is 
removed, and until the cavity is of such a form that 
it will not only contain, but retain, the stopping 
material. On the proper performance of this part 
of the process, much of the after success of the 
operation depends. 

According to the microscopic investigations of those 
eminent odontologists, Uetzius, Frankel, Miiller and 
Owen, a tooth is in reality a bundle of tubes parallel 
to each other, and which contain inorganic deposits 



EXCAVATING CARIOUS PORTIONS. 105 

of calcareous salts. Owen asserts that in excavating 
the decayed portion of a tooth, the above tubes are 
divided; and that after the stopping is introduced, 
they exude a thin firm layer of calcareous matter, 
which intervenes between the material employed for 
filling the cavity and the exposed extremities of the 
tubular orifices. 



EXCAVATING CARIOUS PORTIONS. 

During the process of excavation, the cavity should 
be frequently syringed with warm water, to remove 
any minute fragments of diseased bone ; and before 
the stopping is introduced, the same cavity should be 
carefully rinsed out with a little eau-de-Cologne or 
other spirit, and then dried with a small piece of 
lint or cotton. If the least moisture be allowed to 
remain, it will not only prevent the close packing of 
the stopping material, but will frequently cause the 
latter to fall out. 

The instruments used for stopping vary much in 
size and shape, according to the taste of the ope- 
rator, who has them so constructed as to enable him 
to use them with facility upon any part of a tooth. 
It is unnecessary for us to allude to them more par- 

f 3 



106 EXCAVATING CARIOUS PORTIONS. 

ticularly, than to say, that the dentist should be 
provided with a sufficient variety to suit any pro- 
bable case. 

The cavity having been well prepared, a quantity 
of gold-leaf is cut in strips varying from half an inch 
to an inch in width. One of these strips is now 
loosely folded, and the end of it introduced by a pro- 
per instrument to the bottom of the cavity. In the 
next place, the remainder of the gold, on the outside 
of the cavity, is folded on the first, and then carried 
to the side of the cavity, from whence the folding 
should be commenced ; and so on always to the same 
side ; taking care, as each fold is inserted, that it 
comes in close contact with the bottom, and with the 
metal first and subsequently introduced. The last 
part of each fold should be left somewhat higher than 
the outer rim of the orifice or cavity. This kind of 
packing is to be continued until every part of the 
cavity is perfectly filled, when an instrument nearly 
the size of the orifice should be employed, to give 
the whole solidity, by pressing it firmly toward the 
bottom. After this, a small, round, sharp instru- 
ment should be applied to the edges of the stopping, 
to force it into close contact with the sides of the 
orifice. If more gold than necessary has been used, 
the overplus may be scraped or filed down level with 



EXCAVATING CARIOUS PORTIONS. 107 

the enamel of the tooth. In the last place, the sur- 
face is to be highly polished with a burnisher. 

In the upper jaw, the lateral edges of the front 
teeth are frequently affected with caries. In the 
early stages of the disease it is necessary to stop 
them with gold, but without having recourse to the 
file for the purpose of enlarging the division between 
them, as is generally done, to enable the operator to 
use his instruments with facility. In young persons 
of from ten to eighteen years of age, the use of the 
file should if possible be avoided; for the friction 
caused by it cannot fail to occasion considerable de- 
rangement of structures so delicately organized as 
the teeth, and even in some cases may result in their 
destruction. 

Where it is necessary to stop the front teeth in 
young persons, it is best to separate them by means 
of a thin piece of Indian rubber, stretched to the 
utmost, in which state it is inserted between them, 
and allowed to collapse. By renewing this every 
second day for a week, it will be found that ample 
space is gained to enable the operator to stop the 
teeth without difficulty. After the operation is per- 
formed, the teeth will in a few hours return to the 
natural position, without having sustained the slight- 
est injury. 



108 MATERIALS USED FOR STOPPING. 

Well-stopped teeth have been known to last, and 
be serviceable, for forty years, without pain or in- 
convenience. 

It is a rule, that the operation must not be at- 
tempted so long as a vestige of pain continues. A 
course of palliative treatment must always be under- 
gone previously, whenever internal inflammation is 
present. 



MATERIALS USED FOR STOPPING. 

Much has been written respecting the materials 
which are proper to be used for stopping the teeth, 
and those practitioners have been generally con- 
demned who employ anything but gold for the pur- 
pose. The cements particularly are considered un- 
suitable materials. The American dentists, always 
in earnest, have gone so far as to exclude from their 
Society any one who employs cement stopping. 

That pure gold-leaf is not only the best, but the only 
material that ought, as a rule, to be employed in this 
operation, we ourselves have no doubt. Its tough- 
ness and ductility, the readiness with which it can 
be packed in the tooth, and particularly that noble 
quality by which it resists oxidation and the chemi- 
cal agency of the salts of the saliva, — all these cir- 



MATERIALS USED FOR STOPPING. 109 

cumstances mark it out as especially fitted for stop- 
ping the teeth. It need scarcely be observed, that 
where leaf gold is used, the plate or leaf should bear 
some proportion in substance to the size of the cavity 
to be filled ; that it should be comparatively thick, 
if the cavity be large, and thin in proportion as the 
latter is small in extent. 

Notwithstanding the plain superiority of gold, 
several other materials are used for stopping, which 
on account of their cheapness, and the facility with 
which they can be placed in the teeth, have (un- 
fortunately for the public) many professional advo- 
cates. Most of these materials undergo chemical 
changes from the saliva, and are at once injurious to 
the teeth and to the general health. 

Pure platina may be employed with safety. But 
the platina of commerce is often mixed with other 
metals ; and in any case it is so much less ductile or 
manageable than gold, that it can seldom or ever be 
used with advantage. 

Tin also undergoes but little change in the mouth, 
and may be used with comparative safety ; but lead 
(which is occasionally employed) is readily acted upon 
by the saliva, and becomes highly poisonous. The 
same remark applies to silver-leaf. The salts of the 



110 MATERIALS USED FOR STOPPING. 

mouth act upon it, and convert it into protoxide of 
silver. 

Of the many compounds advertized for stopping, 
all are alike injurious and objectionable. Then 
cheapness is their only recommendation, and this is 
often hypothetical, considering that the health may be 
seriously injured by employing them. Among these 
censurable materials, we have the mineral cement, or 
Sir Isaac Newton's fusible metal, of which the toy 
termed the magic spoon is made. This metal, a 
compound of bismuth, lead and tin, is melted by 
being held a few seconds over a candle or spirit lamp, 
and is inserted into the tooth in a fluid state. The 
temperature required to fuse this metal is that of 
boiling water, and this heat is sufficient to produce 
inflammation in the tooth and its membranes. More- 
over, the metal contracts on cooling, and admits the 
fluids of the mouth into the cavity of the tooth sur- 
rounding it. 

The fusible metal or cement is similar to the mine- 
ral cement, except that it contains two parts of lead 
and a less proportion of bismuth and zinc. 

The mineral marmoretum, mineral succedaneum, 
and mineral petroleum, are the same thing under dif- 
ferent names, viz., silver filings made into an amal- 



MATERIALS USED FOR STOPPING. Ill 

gam with mercury. This compound has all the dis- 
advantages to which we adverted when speaking of 
lead and silver. 

The terro-metallic cement is composed of three 
parts of sulphate of lime and one of rust (oxyd of 
iron) , and is inserted into the tooth in the form of a 
paste, which soon hardens, and in a few hours dries, 
crumbles, and falls out. 

The celebrated anodyne cement is similar to the 
above, but with the addition of a small quantity of 
morphia. 

Vegetable cements are composed of gum-mastic, 
ammoniacum, sandrack, &c, dissolved in spirits of 
wine, and evaporated to a proper consistence. A 
small piece of this residuum is placed in the tooth, 
where it requires renewing every two or three weeks. 

From the above account it may appear, that gold 
is the only substance that is free from objection as a 
material for stopping. Nevertheless there are cases 
in which it is justifiable to use other materials ; as 
those composed of vegetable gums, which are avail- 
able chiefly as temporary stoppings until the condi- 
tion of the tooth will allow of gold being employed. 



( 112 ) 



ASBESTOS STOPPING. 

This curious substance, named* from resisting the 
power of fire, is not acted upon by the strongest 
acids, either vegetable or mineral; indeed, in the 
present state of chemical knowledge, it has no known 
solvent. Its unchanging nature in the presence of 
chemical agency, marks it out as especially adapted 
for stopping, and it is further fitted for the purpose, 
inasmuch as it is a bad conductor of heat. The latter 
quality is particularly available in cases of decay, 
where the cavity is large, in which, if metal alone be 
used, its sudden expansion and contraction, and its 
property of concentrating and conveying heat, fre- 
quently produce great inconvenience. For it is a 
well-known fact, that when a large cavity is stopped 
with nothing but metal, considerable pain sometimes 
arises from taking liquids that are either above or 
below the natural heat of the body. In such cases 
a non-conductor of heat should be interposed be- 
tween the lower part of the cavity and the metal, 
by which not only the quantity of the latter is 
diminished, but its contact with the tooth cut off. 
By attention to this hint, the operation of stopping 

* From the Greek a, not, and (r/Jewv/«, I extinguish. 



ASBESTOS STOPPING. 



113 



large cavities will be oftener successful than at pre- 
sent. Our own experience bears us out in this ob- 
servation. In small cavities, however, asbestos is 
not required, because the expansion of the metallic 
stopping is too slight to have painful consequences. 



CHAPTER X. 



ALVEOLAR ABSCESS AND GUM-BOIL. 

Of all the disorders to which the teeth and gums are 
liable, none is more painful, or, if allowed to pro- 
ceed, more injurious to the surrounding parts, than 
alveolar abscess. It usually begins at the end of the 
fang, but occasionally even on the inside of the 
palate. A variety of causes may produce it, but the 
most frequent of these is irritation and local inflam- 
mation arising from the fang or root of a carious 
tooth. Even sound teeth, however, are liable to be 
attacked by it, either in consequence of cold, or 
mechanical violence, which frequently produces in- 
flammation and thickening of the membranous cover- 
ing of the fang. Whatever cause it may arise from, 
the inflammatory action should be relieved as speedily 
as possible, otherwise it may increase, and extending 
to the neighbouring parts, produce suppuration, and 
eventually absorption and exfoliation. In the latter 
case, the whole system is affected by the pain, and 
the matter issues, either externally or internally, in 
a constant discharge of fetid pus. 



ALVEOLAR ABSCESS AND GUM-BOIL. 115 

The treatment should commence when tenderness 
is first felt in the tooth or gum on closing the mouth, 
and should consist in the application of a leech to 
the gum, and in the exhibition of a saline purgative, 
or of an aperient pill composed of six grains of com- 
pound extract of colocynth, three grains of calomel, 
and three drops of oil of carraway, to be taken over 
night. 

If the inflammation is reduced by these means, 
and neither pain nor tenderness remain, and the 
tooth has become comparatively firm, an astringent 
lotion, as follows, may now be employed to fix it : 
Dissolve one drachm of alum in a pint of water ; to 
this add one ounce of tincture of rhatany, and three 
drachms of tincture of pellitory. Dilute this lotion 
with warm water, and wash the mouth with it three 
or four times a day. 

On the other hand, if the disease has proceeded 
without recourse to proper remedies, or has been 
irritated and increased by improper applications, as 
creosote, oil of cloves, or any other strong stimu- 
lants, it then becomes imperative at once to remove 
the exciting cause, viz., the decayed tooth or stump. 
After this, the application of a roasted fig, or of warm 
water, will generally suffice to complete the cure. 

The presence of a stump may generally be regarded 



116 ALVEOLAR ABSCESS AND GUM-BOIL. 

as the cause of this complaint, where the crown of a 
tooth has decayed, or has been broken away in the 
effort to extract it. 

Out of many cases that have come under our care 
at the Metropolitan Free Hospital and in private 
practice, we select the following ; which will serve to 
point out the necessity of early treatment in this 
disease. 

John Ward, aged 27, a baker by trade, applied 
for relief at the above Hospital. He had an opening 
in the right cheek opposite the first molar tooth, 
from which opening fetid pus had discharged at 
intervals for the last five years. Whenever the dis- 
charge ceased, acute pain was experienced in the face, 
attended by swelling and disfiguration of the features. 
His constitution was so impaired, that he was fre- 
quently obliged to discontinue his employment. His 
frame was emaciated; his appetite bad; his bowels 
costive; and his sleep restless and disturbed. 

At several hospitals and dispensaries he had been 
treated for salivary fistula, and injections and caustic 
had been freely applied. Certainly appearances jus- 
tified this mode of treatment, for no trace of a stump 
could be discovered ; nor were any of the neighbour- 
ing teeth affected with caries, or with inflammation 
of the membrane of the fang. 



ALVEOLAR ABSCESS AND GUM-BOIL. 117 

I questioned him whether he had ever had a tooth 
broken in the jaw, and he said that such a thing had 
occurred ten years previously in an attempt at ex- 
traction ; but the gum had closed over the part, and 
he had felt no more of it. Upon introducing a small 
curved silver probe into the external opening, I 
found that it took the direction of the alveolar pro- 
cess, and came into contact with a hard substance, 
pressure upon which caused acute pain. There was 
now no doubt as to the cause of the disease. 

Some difficulty existed respecting the best mode of 
removing the buried stump without producing per- 
manent deformity. First, the integuments were 
carefully separated, and about a quarter of an inch 
of the external wall of the alveolar process was re- 
moved. This allowed the introduction of a strong 
curved and pointed elevator for extracting the stump. 
The extraction was effected, though by no means 
easily; after which the opening was injected with a 
lotion made by dissolving two grains of sulphate of 
zinc in two ounces of rose-water. In three weeks, 
by attention to the general health, — by the use of 
tonics and aperients, and a wholesome diet, — the 
opening closed • and the patient has ever since been 
free from his distressing complaint. 

The following case occurred in private practice : 



118- ALVEOLAR ABSCESS AND GUM-BOIL. 

the subject of it was an interesting young lady, 17 
years of age. She consulted me for a fetid discharge 
that issued constantly from a small opening imme- 
diately under the chin, and which had now existed 
for three years. During this time the disease had 
prevented her from appearing in society, and was 
attended by lancinating pains, which ran along both 
sides of the jaws to the ears and breasts. Medical 
advice had been taken, and the orifice had been re- 
peatedly cauterized and poulticed, but without reliev- 
ing the pain or healing the part. 

On passing a curved probe up the sinus or opening, 
it went distinctly to the fangs of the two central 
teeth in the lower jaw, which to all appearance were 
perfectly healthy, but nevertheless, when they were 
sounded, the patient experienced paroxysms of pain 
similar to those she had been in the h%bit of feeling 
in the course of the disease. 

She now remembered, that two years previous to 
the commencement of the discharge, she struck 
these two central teeth while playing with her sister. 
The accident caused some pain at the time, but this 
soon subsided, and no further notice was taken of 
the circumstance. Subsequently a small but painful 
pimple appeared under the chin, and eventually 
broke, forming the orifice already described. 



ALVEOLAR ABSCESS AND GUM-BOIL. 119 

She submitted at once to have the above teeth 
extracted. The parts were then injected daily with 
warm water, and by attention to her general health 
under the care of her medical attendant, she per- 
fectly recovered ; and I had the satisfaction of hear- 
ing some time afterwards, that she had returned to 
the country, and had not experienced any renewal 
of pain or inconvenience. 

The following cut exhibits a case of alveolar ab- 
scess with exfoliation, arising from irritation. 




In certain cases, particularly where treatment has 
been delayed, or improper applications employed, 
exfoliation takes place, and considerable loss of sub- 
stance may result. The following cut represents a 
case of the kind that occurred in a child ; in which 



120 ALVEOLAR ABSCESS AND GUM-BOIL. 

the alveolar process of the front deciduous molar 
and of the left permanent incisor has exfoliated. 

Whenever pain or tenderness is felt in one or 
more of the teeth, the symptoms being similar to 
those we have mentioned, the sufferer should lose no 
time in consulting a dentist, who will at once care- 
fully examine and sound the teeth, so as to ascertain 
the nature of the complaint before it is too late. 
Should it happen that the services of a dentist can- 
not be obtained, the remedies above described may 
be used with a good prospect of success. 

When the disease of which we are treating exists 
in the upper jaw, it may assume a most serious form, 
particularly if it be caused by the irritation of a de- 
cayed tooth opposite the antrum. If a case of this 
kind be allowed to proceed, total destruction of the 
face, and fatal consequences, may be the result.* 

* "The formation of abscess in this cavity might, however, in 
almost every instance, be prevented, by the timely adoption of proper 
treatment. On the occurrence of severe, deep-seated, and throbbing 
pain in the upper part of the alveolar ridge, or just above it, in the 
region of the antrum, such as has been described as attending the 
formation of abscess in this cavity, or in that of the alveolus of a 
superior molar ; or if the tooth directly beneath the place where it 
was first felt, be considerably decayed, or its lining membrane ex- 
posed ; or if it be dead, loose, or its socket much diseased, it should 
be immediately extracted. By this simple operation, the formation of 



FILING. 



121 



Once more then let us urge the necessity of im- 
mediate care in this disease, which, however trivial 
it appear at first, may turn out, by even short neg- 
lect, to be fearfully dangerous and destructive. 



FILING. 

The operation of filing is one that the practical 
dentist is almost daily called upon to perform, and 
from which, if it be judiciously and effectually em- 
ployed at the commencement of disease, the most 
beneficial results may be expected. 

In consequence of a crowded state of the mouth, 
of the premature development of the teeth before 
the maxillary arch is large enough to admit them, or 
else of uncleanliness, the permanent central and late- 
abscess, not only in the socket of the tooth, but also in the antrum, 
may in almost every instance be prevented. If, however, it be not 
followed by an immediate subsidence of pain, leeches should be applied 
to the gums and fomentations to the cheek. If the patient be of a 
full habit, and if there be any general febrile symptoms, saline pur- 
gatives may also be employed with advantage. But in the majority of 
cases, the extraction of the tooth will be all that is required to arrest 
the progress of the disease." (Dr. C. A. Harris, On the Diseases of 
the Maxillary Sinus ; page 463.) 



122 



FILING. 



ral incisors in the upper jaw frequently decay at their 
sides at an early period ; and hence it is that these, 
together with the canine teeth in the same jaw, de- 
mand the use of the file more frequently than the 
other teeth. It may, however, be successfully em- 
ployed on the bicuspid and molar teeth, either upper 
or under. 

Caries arising from any of the above causes, if 
allowed to extend beyond a certain limit, renders the 
operation of stopping difficult to the operator, and 
hazardous to the tooth, owing to the confined space 
in which the stopping instruments must be used. This 
difficulty is of common occurrence, particularly where 
the disease has advanced to the cutting edge of the 
tooth; and it makes it impracticable to form a cavity 
of proper size and shape to retain the metal. Even 
should it be surmounted to the operator's satisfaction, 
the walls of the cavity will most probably be broken 
down in the attempt to stop it, or the stopping will 
fall out in the course of a few months. 

In cases requiring the use of the file, the dentist 
ought not, in our opinion, to content himself with 
merely dividing the teeth, but should continue the 
operation until the whole disease is eradicated, and 
the affected tooth has as white and smooth a surface 
as its sound neighbours. Where the operation can be 



FILING. 



123 



managed, a considerable portion of a tooth (espe- 
cially of the posterior part) may be taken away with- 
out perceptible disfigurement, and without making 
matters worse in the mouth. Undoubtedly we are 
no advocates for the removal of the enamel, which is 
the natural covering of the teeth ; nevertheless neces- 
sity frequently compels us to resort to it as the only 
means of preservation. It is not requisite to use the 
file in all cases ; in some the disease may be simply 
scraped away. 

The teeth are more highly organized in young 
than in old subjects, and hence it is that the former 
are generally more liable to suffer pain from the 
operation of filing. Where this is the case, the ope- 
ration may be deferred for a few days, and the parts 
treated in the manner we shall hereafter mention. 

We find the teeth best adapted for the use of the 
file, to be the four front incisors, the canines, the 
bicuspids, and, if their position be favourable, the 
molars. In the latter, however, the caries has for 
the most part gone too deep before the patient dis- 
covers it, for the file to be available. Still it may be 
prudent to attempt the treatment by filing, though 
success is very uncertain, but where this fails, the 
teeth may notwithstanding be preserved by stopping, 

The manner in which incipient caries between the 

g 2 



124 



FILING. 



two laterals or centrals may be removed with as little 
disfigurement as possible to the front aspect of the 
teeth, is as follows. First make a clear division 
down to the gum with a moderately thick file : then 
remove the caries from the back of the tooth with a 
bent scraper ; and meanwhile support and steady the 
teeth with the left finger and thumb. 

Having removed the caries, the dentist is next to 
employ a finer file to take off" any roughness left by 
the first filing, so as to prevent foreign substances 
from lodging in the part ; and he is then to employ a 
third and still finer file ; and lastly, to polish the 
surface by means of a piece of common cane, with 
chalk and finely-powdered pumice-stone. If pain 
occur during the operation, he should immediately 
desist, and postpone it for a few days, and endeavour 
to allay irritation by occasionally applying a mixture 
of spirits of wine and morphia, as follows : 

R Spt. Vini Uect., 3 drs. 
Acet. Morphise, 3 grs. 

Mix. 

After the operation is completed, we always pro- 
vide our patients with a piece of cane deprived of its 
bark, and the shape of which is represented in the 
following cut. This we request him to use night 



FILING. 



125 



and morning, to maintain the polish we have given, 
and to remove extraneous matter from the surface of 
the tooth ; as otherwise such matter might produce 
a recurrence of the disease. 

Notwithstanding precautions, caries will some- 
times renew its attack on the same tooth, but gene- 
rally on some other part than the one already treated. 
Where such an event occurs, it is to be attributed to 
a general defect in the structure of the tooth. 

Often, on dividing a tooth, a large cavity is dis- 
covered near its cutting edge ; which cavity it is im- 
possible to remove without destroying the tooth and 
disfiguring the patient. In these cases, gum-mastic 
steeped in warm water should be inserted : it will 
remain in the cavity for months, and can be renewed 
at pleasure by the patient himself. In many in- 
stances of the kind, I have found on examining the 
teeth three or four years afterwards that such cavities 
were perfectly free from disease. 



CHAPTER XI. 

SALIVARY CALCULUS OR TARTAR. 

Tartar is a peculiar earthy deposit found almost 
universally on the teeth of all classes, ages, and con- 
stitutions. Some physiologists affirm it to be a pe- 
culiar secretion; among whom M. Serres is conspi- 
cuous, from having asserted that it has its own proper 
secretory glands. Jourdain thinks that it is secreted 
by glands scattered over the periosteum of the teeth. 
Others contend that it is nothing more than particles 
of food first dissolved in the saliva, and afterwards 
deposited on the teeth and other immoveable parts, 
whether natural or artificial, within the cavity of the 
mouth ; being constantly formed on the gold, ivory 
&c, used in the formation of artificial teeth. It 
occurs however more particularly on the parts adja- 
cent to the salivary ducts, as at the back of the 
lower incisors and on the outer surfaces of the upper 
molars. 

The tartar, formed principally of inorganic phos- 
phate of lime, is originally deposited over the whole 



SALIVARY CALCULUS OR TARTAR. 127 

surface of the teeth alike, whence it is removed from 
the prominent parts by the action of the tongue and 
lips. It has often been analyzed chemically. The 
results have been various, owing no doubt to a differ- 
ence in the character of the deposition itself. 

According to M. M. Vauquelin and Lanquor, tar- 



tar is composed of 

Water 7 

Salivary Mucus 13 

Phosphate of Lime, with some trace of Magnesia . . 66 

Carbonate of Lime 9 

Animal Matter, soluble in muriatic acid 5 

100 

Berzelius gives the following : 

Salivary Matter 1 

Mucus 12 5 

Phosphates of Lime and Magnesia 79 

Animal Matter, soluble in muriatic acid 7 5 

100 



Under the microscope, tartar is seen to consist of 
numberless fossil animalcules embedded in, and in- 
termixed with, the earthy phosphates and the other 
matter of which it is formed. 

If a piece of tartar be taken from the mouth of a 



128 SALIVARY CALCULUS OR TARTAR. 

person who has fasted for some time, and from that 
part of the neck of the tooth embraced by the gum, 
and if it be submitted to the microscope, it is said a 
number of these animalcules will be discovered, and 
that their debris not only contributes to produce the 
tartar, but occasions the disagreeable fetor that so 
often attends any large accumulation of this sub- 
stance. There are, however, several kinds of tartar, 
differing from each other not only in colour, density 
and chemical composition, but also in their effects on 
the teeth and the other parts with which they are in 
contact. 

Thus there is a soft tartar, of a chalky consistence 
and light brown colour, which is generally found to 
accompany that delicacy of frame and skin which 
indicates a strumous or consumptive habit. 

Another kind is met with, of a dark colour, ap- 
proaching to black, much harder in consistence than 
the former, and which adheres firmly to the teeth, 
is much slower in depositing, and in time acquires 
an almost crystalline character. 

There is also a third kind, less common, however, 
than the preceding, but far more destructive in its 
effects. It is generally of a dark green colour and 
small in quantity, but causes erosion and scaling off 
of the enamel. 



SALIVARY CALCULUS OR TARTAR. 129 

The saliva itself sometimes assumes an acid cha- 
racter, and produces a slow and soft decay of the 
teeth. Occasionally those on one side of the mouth 
fall victims to this decay, and in many instances even 
the ivory plate of a set of artificial teeth is corroded 
on one side more than on the other. This arises no 
doubt from the secretion of one parotid gland being 
vitiated, while that of the opposite gland continues 
healthy. 

The eight or ten varieties of tartar described and 
individualized by some authors, are but modifications 
of the three above mentioned, and are produced by 
the effect of medicines, by the constant use of 
tobacco, or by the stain of port and other wines, 
producing a difference in the colour and appearance 
of this substance. 

The first kind of tartar then may be described as 
a chalky mass, having a slightly alkaline taste, and 
varying somewhat in colour, according to the habits 
of the person in whose mouth it is found. 

The second is hard and firm, of considerable den- 
sity and of a dark colour, and adheres to the teeth 
with great pertinacity. 

The third kind is a thin film of matter of a green- 
ish colour and very acrid character. 

o 3 



130 SALIVARY CALCULUS OR TARTAR. 

As far as the teeth are concerned, the first kind is 
perfectly innocent, for on its removal the surface of 
the enamel and the teeth themselves will be found 
uninjured. 

Tartar is first deposited as a soft earthy matter, 
which becomes coherent by the agency of mucus and 
saliva, and occupies the angles formed by the edge of 
the gums and the necks of the teeth. If it be 
allowed to remain, it soon grows hard, and is a 
constant source of irritation to the gums, the edges 
of which gradually become inflamed and thickened, 
thus forming a ledge for a larger quantity of the 
deposit. This accumulates in every direction, up- 
wards towards the crowns of the teeth, and down- 
wards towards the gums, as well as between the gums 
and the teeth. 

In some cases the accumulation takes place to such 
an extent, that the fangs are exposed, and the teeth 
themselves are only kept in their places by being 
cemented by the tartar to the adjoining teeth, and 
by the cord of vessels at the end of the fang, which 
then are much enlarged and form a strong and tough 
ligament. 

It is clear therefore that tartar, however harmless 
in some respects, should never be left undisturbed, 



SALIVARY CALCULUS OR TARTAR. 131 

since its mechanical action, and the inflammation it 
produces in the gums and alveolar processes, will 
sooner or later destroy the teeth. 

Some patients, it is true, object to the removal of 
this substance, although a source of inconvenience 
and injury to themselves, and of annoyance to others 
from the offensive smell which it gives to the breath. 
To such we would remark, that the operation of 
scaling is the most simple and innocent imaginable, 
and unaccompanied by pain; being in fact but the 
removal by appropriate instruments of an extraneous 
substance, which the tooth-brush is inadequate to 
bring away. But of this we shall speak more pre- 
sently. 

The third kind of tartar appears originally as a 
discoloured arch around the fronts of the teeth, close 
to the edges of the gum. It should be removed at 
once, and the enamel under it well polished, to pre- 
vent its re- deposit : otherwise it will repeat its attack 
on the enamel, and completely denude the teeth, the 
crystalline appearance of the enamel being destroyed, 
after which the subjacent osseous substance will 
suffer, and soon become carious. 

The following engraving represents the loss of the 
four central teeth of the lower jaw from the accumu- 
lation of tartar. 



132 



SCALING. 




The next cut represents the teeth of the lower 
jaw completely embedded in tartar. It is taken from 
a girl, 18 years of age, who applied for advice at the 
Metropolitan Hospital. 




When tartar is present, there is more or less con- 
gestion and tumefaction of the gums, which acts as 
a powerful cause of injury to the teeth. 



SCALING. 



When tartar has accumulated on the teeth, it is 
essentially necessary, as we said before, that it should 



SCALING. 



133 



be at once removed. The operation of removing it 
must be performed with great care, and without any 
violence, for otherwise the enamel may be chipped or 
injured, and premature decay of the teeth ensue. 
As a rule, the patient ought to feel no pain during 
the operation. 

The modes of using the scaling instruments will 
be readily suggested to the operator by their respec- 
tive shapes. 

When by their successive application the whole of 
the tartar has been removed, the teeth should be 
gently rubbed with a piece of cane deprived of its 
bark, and dipped in tooth-powder. This is necessary 
in order to remove the roughness that is always left, 
in consequence of small pieces of tartar escaping the 
instruments, and which, if it were not removed, 
would serve as the nucleus for a fresh deposit of the 
same kind ; and moreover would communicate a very 
unpleasant sensation to the tongue. 

In cases where the accumulation of tartar is so 
great as to cause inflammation and turgidity of the 
gums, with loosening of the teeth, it is well to 
remove a portion only at one sitting (and this, with 
more than ordinary care) ; and then to wait a few 
days until the teeth and gums have recovered from 
the first operation. In the meantime, much benefit 



134 SCALING. 

may be derived from the use of the following astrin- 
gent lotion : — 

R Tincture of Rhatany, 2 ounces. 

Alum \ drachm. 

Tincture of Pellitory, \ ounce. 
Eau-de-Cologne ... 2 ounces. 

Add a teaspoonful of this lotion to half a tumbler 
of water, and brush the teeth and gums with it two 
or three times a- day. 

If the gums are tender and spongy after the tartar 
is all removed, the use of the same lotion may be 
continued. Indeed, in all cases in which tartar has 
been removed, it is expedient to use the above lotion 
as well as a tooth-powder (not containing acid) once 
at least during the day. 

It is to be regretted that there are persons calling 
themselves dentists who are in the habit of employ- 
ing some one of the dilute mineral acids to facilitate, 
as they express it, the operation of scaling. This un- 
principled procedure dissolves the enamel and earthy 
parts of the teeth, and makes them beautiful and 
white for a few days, at the expence of their total 
ruin in less than a twelvemonth afterwards. 

The operation of scaling is in itself all-sufficient 
for the purposes that it is intended to answer. 



( 135 ) 

GUARDING THE TEETH AGAINST ACID MEDICINES. 

We have just referred to the pernicious effects 
which the dilute mineral acids may exert on the 
dental organs. Now these acids are occasionally 
given internally as medicines, and are frequently in- 
gredients in gargles and lotions for the mouth. But 
from what has been already stated, it is obvious that 
they cannot be long used thus without doing great 
and often lasting injury to the teeth. To prevent 
this, the dose about to be taken is sometimes placed 
in a glass tube, which is emptied of its contents at 
the back of the mouth. This however is an unsafe 
expedient, for the tube may break, and wound the 
adjacent parts ; nor does it fully answer its purpose, 
since some of the acid is sure to mix with the saliva, 
and thus to diffuse itself over the whole mouth and 
teeth. 

The best method to avoid the hurtful consequences 
arising from the exhibition of these acids, is to place 
in the mouth a few pieces of gum-arabic, or a few 
jujubes, some minutes before the medicine is taken, 
distributing the mucilage over the teeth by means of 
the tongue : then, quickly swallowing the medicine, 
immediately to wash out the mouth with water in 
which a small quantity of carbonate of soda or potass 



136 GUARDING THE TEETH AGAINST ACID MEDICINES. 

has been dissolved. In this case the vegetable gum 
sheathes the teeth without the acids being enabled 
to act upon it ; after which, the alkali (soda or potass) 
neutralizes any small quantity of acid that may re- 
main in the mouth, and that, when the mucilage is 
washed away, would otherwise injure the enamel. 



CHAPTER XII. 



EXTRACTION AND ITS INSTRUMENTS. 

The operation of extraction should never be resorted 
to in the early stage of caries, or until all other 
means have failed, or the surrounding parts are so 
diseased that it would be hazardous and useless to 
persist in filling the tooth, with the view of making 
it available for future use. Bushels of teeth are, we 
fear, taken out without proper forethought. But 
the dentist ought to be deeply impressed with the 
responsibility of his calling ; and ought always to 
lean to the belief, that the teeth, like the rest of the 
frame, are meant to last for life, however the inten- 
tions of nature may be contravened by luxury, dele- 
terious medicines, or want of early attention to 
cleanliness. At any rate he, the preserver of the 
teeth, should never debase his art, by making it 
consist entirely in the dextrous use of the key or 
forceps. 

There are, however, many cases in which extrac- 
tion is quite necessary, and in which it is the practi- 



138 



EXTRACTION 



turner' s duty to decide what instrument is best 
adapted to remove the tooth with the least amount of 
pain and danger to the patient. For whatever may 
be said to the contrary, the variety of cases requires 
a variety of instruments. 

Some controversy and even warmth of feeling have 
existed respecting the invention of the improved 
forceps. We hear it asserted, on the one hand, by 
various parties, that they are themselves the inven- 
tors of that instrument : on the other hand, there 
are those who urge that the said forceps was in com- 
mon use in the days of our ancestors. This is a 
matter of slender interest to us. But what is of 
more importance, both the above parties agree in 
depreciating all other instruments than the forceps, 
and in lauding it alone as fit to be employed for the 
extraction of teeth, no matter of what description. 
And though the forceps, like any other instrument, 
is adapted to particular cases only, many young 
practitioners, fortified by the example of some of 
their elder professional brethren, assert that all their 
extractions are performed by that instrument. With 
their statistics of crushing they do not furnish us, 
although these might help to set the question at 
issue between them and us, in a strong light. 

That great ingenuity has been exercised in the 



AND ITS INSTRUMENTS. 



139 



construction of forceps, we have no wish to deny, 
Their use, however, is limited, as their employment 
should be, to cases in which decay has only exposed 
the lining membrane of the tooth, leaving sufficient 
substance of bone to withstand their pressure. On 
the contrary, where the crown is much decayed, the 
mere effort to detach the tooth, and the pressure 
necessary to prevent the instrument from slipping, 
will be greater than the remaining substance can 
bear without breaking. For this reason we have our 
misgivings when we hear it said that the forceps 
alone is made use of in every case. Surely either 
extraction must be performed where the tooth might 
be saved by stopping ; or the operators must be very 
fortunate in their patients ; or else they must each 
have large cabinets of broken teeth. 

The forceps, then, as we before observed, are ad- 
missible only where there remains enough of the 
bony structure of the tooth to resist their grasp. 
Where this is the case, they should be so constructed 
as to fit the neck of the tooth, which the inner sur- 
face of the blades should be sufficiently expanded to 
grasp without exerting pressure on the crown ; and 
they should be of such a size as to afford an easy 
purchase to the hand of the operator. The latter 
should be provided with at least eight pairs of them, 



140 



EXTRACTION 



of different sizes and shapes, adapted to the different 
sizes and positions of the teeth. 

For the extraction of the upper incisors and cuspi- 
dates, one pair only is necessary, as in the following 
cut. 




For the removal of the bicuspids in the upper jaw, 
the blades of the forceps should be slightly curved, 
and narrower in the inner groove of the blade than 
in the outer ; as here represented. 




For the first molars the instrument may be either 
slightly curved, or straight, as follows. 




For the second molars the forceps should be con- 



AND ITS INSTRUMENTS. 141 

siderably curved. The annexed drawings give a front 
and lateral view of the shape required. 




The dentes sapientise or wisdom teeth of the upper 
jaw, require for their extraction an instrument bent 
above the joint, so as to form two right angles, as 
below. 




For the removal of the incisors, cuspidates, and 



142 EXTRACTION 

bicuspids of the lower jaw, the hawkVbill forceps is 
necessary. 




The first and second molars are extracted by means 
of a curved forceps. 




For extracting the dentes sapientise in the lower 
jaw, the forceps should be somewhat curved, with 
the mouth of the blades as here represented. 




The next cut represents a pair of forceps intended 
for the removal of stumps in the upper jaw. 



AND ITS INSTRUMENTS. 



143 



For the lower jaw, it will in most cases be ne- 
cessary to have the forceps curved more nearly at 
right angles, as the following. 



When in each particular case a pair is selected for 
use, care should be taken that they embrace the neck 
of the tooth only as far as the alveolar process, or a 
serious loss of that bone may ensue : while, if the 
crown itself be taken hold of, the tooth will in all 
probability be crushed by the pressure employed for 
its removal. Having fixed the forceps properly, alter- 
nate lateral motions tending to the perpendicular are 
given to them in quick succession ; the one motion 
being designed to separate the tooth from its adhe- 
sions with the socket, the other, to draw it out of the 
same. 

These observations apply to the whole of the teeth 
in both jaws, except the upper incisors, for the ex- 
traction of which latter it is necessary to use a half 
rotatory motion, as well as the alternate lateral mo- 
tion spoken of above. 




144 EXTRACTION 

The following plate represents one of tWse acci- 
dents that may occasionally occur during the employ- 
ment of the forceps ; and in which, either from using 
too large an instrument, and taking hold of the 
alveolar process, or from embracing two of the teeth 
at once, a considerable piece of the alveolus has been 
torn away. 




Wherever caries has destroyed the substance of the 
tooth, so as to leave only the walls or shell of the 
enamel on either side, the use of the key instrument 
becomes imperative. 



AND THE INSTRUMENTS EMPLOYED. 145 

The fulcrum of this instrument is oval, and covered 
with Indian rubber, over which a padding of lint is 
wrapped, to prevent undue pressure against the soft 
parts. The claw should be long enough to reach 
easily over the crown of the tooth to the opposite 
part. For the convenience of shifting it to either 
side, the upper part of the shank is hollow, and 
has a spiral spring inserted in it, with a circular 
bolt attached, and passing through the end of the 
claw and the upper part of the fulcrum, at the extre- 
mity of which there is a small button, A, by pulling 
which the spiral spring is compressed, and the claw 
readily removed. 

The application of the fulcrum must depend some- 
what on the state and position of the carious portion 
of the tooth ; but the claw should be so placed as to 
come on the neck of the organ, close to the edge of 
the alveolus, and parallel with the upper part of the 
fulcrum, the bite of the claw and this part of the 
fulcrum being in the same horizontal plane. 

The operator, having properly adjusted the instru- 
ment according to the above directions, next, by 
gently and firmly turning the wrist (care being taken 
in the meantime that the claw or fulcrum does not 
slip), causes the upper part of the tooth to act as a 
powerful lever for moving the lower part and for di- 

H 



146 



EXTRACTION OF STUMPS. 



lating the corresponding portion of the socket, which 
by its lateral enlargement makes room for the tooth as 
it is raised by force out of its situation in the mouth. 

It is true that mischief may and sometimes does 
occur from unskilful use of the key as well as of the 
forceps, and the same may be said of every instru- 
ment used in surgery. This, however, is clearly no 
objection to one instrument more than to another. 

Below we have figured one of the worst forms of 
careless application of the key. 




EXTRACTION OF STUMPS. 

For the removal of deeply-seated stumps in the 
back of the jaws, whether such stumps are products 
of disease, or remain after the improper or unsuc- 
cessful use of the forceps or key, an admirable in- 
strument has been contrived by Mr. Bell, of the 



EXTRACTION OF STUMPS. 147 

principle of which the following is an application. 




This instrument is called an elevator. It is very 
simple in its construction, and is not difficult to use. 

The point of the instrument is introduced between 
the stump and the alveolar process, and the former is 
then poised out by gently, yet firmly, depressing the 
wrist ; but great care and experience are necessary to 
prevent the elevator from slipping, and injuring the 
mouth of the patient. 

The six front teeth in the upper jaw are sometimes 
so completely hollowed out by decay, as to render 
the success of an operation for their removal ex- 
tremely doubtful, on account of the thinness of the 
outer walls rendering them incapable of bearing the 
pressure either of the forceps or elevator. For these 
otherwise forlorn cases an invaluable instrument has 
been invented by Dr. S. P. Hullihen, of America, 
a representation of which we here append. 



148 



EXTRACTION OF STUMPS. 




The manner of using this instrument is by first 
grasping the upper extremity of the screw between 
the blades of the forceps, and gently turning the 
handles of the instrument so as to drive the screw 
into the root of the tooth as far up as possible ; the 
blades are now opened, and pushed forward on the 
fang, which is grasped and extracted in the usual 
manner. On the advantages which this instrument 
has over every other for these cases, Dr. H. very 
justly insists, "It prevents the root from being 
crushed : it acts as a powerful lever when a lateral 
motion is given : it is likewise of service when the 
rotatory motion is made. It prevents the forceps 
from slipping or their action being lost, should even 
one side of the root give way in the act of extracting 
it; and it is used with equal advantage where one 
side of the root is entirely gone." 

In our own practice we have had many oppor- 
tunities of testing the merits of this invention, recent 
though it be, and we can safely affirm that it is one 
of the most valuable auxiliaries to the scientific prac- 
tice of dental surgery ever introduced. 



CHAPTER XIII. 



NERVOUS AFFECTIONS OF THE FACE FREQUENTLY 
MISTAKEN FOR NEURALGIA OR TIC DOLOUREUX. 

A reference to the frontispiece of the present work 
will shew the intimate connexion that subsists be- 
tween the nerves of the teeth and those of the head, 
neck, brain, &c. Now when we consider this con- 
nexion, it will be scarcely surprising that nervous 
affections of the face are frequently mistaken as to 
their character, and treated as if they were constitu- 
tional and not local complaints. The fact is that 
comparatively few cases of true constitutional neu- 
ralgia are to be met with, though thousands are 
treated as such, which, if the teeth were closely 
examined, would be found to depend on deep-seated 
stumps, that possibly may have lain hid under the 
gum for years, and there have escaped the observa- 
tion of both the patient and his medical attendant. 
Moreover, carious teeth will often cause an attack of 
neuralgia, perhaps in the face or neck, or at some 
considerable distance from the source, viz., the affected 
tooth, which at the time may itself be free from pain. 



150 NERVOUS AFFECTIONS OF THE FACE. 

Derangement of the digestive organs may, and doubt- 
less frequently does, give rise to neuralgic affections ; 
yet in ninety-nine cases out of a hundred such affec- 
tions are grounded on the irritation of a diseased 
tooth, excited either by exposure of the nerve, or 
else of the upper part of the teeth in consequence of 
recession of the gums, or by a diseased fang : and 
they are at first purely local in their character. After 
a time, it is true, general and constitutional symp- 
toms set in, but even then the removal of the dis- 
eased tooth, or proper treatment of the fang, will 
frequently both put an end to the paroxysm, and 
prevent its return. 

Medical authors assert, that genuine neuralgia may 
be known by the periodicity of its attacks ; but this, 
like many other imperfect generalizations, has led 
the mind away from profitable observation; and 
caused the profession to disregard those diseased 
organs which are frequently the exciting and pal- 
pable sources of the nervous affections now under 
consideration. In consequence, the medical practi- 
tioner too often neglects an appeal to the teeth in 
cases where a proper examination, instituted before 
the disease has assumed a formidable character, might 
at once point to the relief of the patient by suggest- 
ing a removal of the cause of the suffering. 



NERVOUS AFFECTIONS OF THE FACE. 151 

To shew the necessity there is, in cases of facial 
pain, for an examination of the teeth by a dentist, 
before any mode of treatment is decided upon, we 
here subjoin two cases that came under our care in 
private practice, and which, we hope, will convince 
the reader, from a practical ground, of the mutuality 
that exists between different parts of the nervous 
system. 

Case I. We were consulted by a lady, about 
twenty-two years of age, who for eight months had 
suffered pain in the branches of the maxillary nerves, 
superior and inferior, which pain at first came on in 
irregular paroxysms, but had latterly been distinctly 
periodical, invariably commencing at 9 o'clock, a.m., 
and at 7, p.m. The severe character of the attacks 
generally lasted for about an hour. They seldom 
occurred at any other times than those above speci- 
fied, unless the patient was suffering from indispo- 
sition or mental disquietude. Early during her 
sufferings she was persuaded to apply brandy and 
salt, with mustard poultices, &c, but these had no 
good effect. She then consulted an eminent physi- 
cian, who ordered various preparations of iron com- 
bined with quinine, which medicines were continued 
for two months without the slightest relief. Bella- 
donna was next tried, commencing with a grain 



152 NERVOUS AFFECTIONS OF THE FACE. 

night and morning, an hour before the paroxysms 
came on. Leeches and blisters were applied to the 
temples, with fomentations of poppies and chamo- 
miles, and the dose of belladonna was increased by 
half a grain each time until three grains were taken 
twice a day. She now became so much affected with 
sickness, vertigo, dimness of sight, &c, that this 
treatment was discontinued, and ioduret of potass 
substituted, with the external use of veratrine. 

These measures were pursued unsuccessfully for 
six weeks, when it was suggested by a medical friend 
that the disease possibly originated in a diseased 
tooth ; and under this suggestion, we were consulted 
on the case. 

On examination it was found, that all the teeth 
of the lower jaw, from the canines to the dentes 
sapientise, were carious ; and that the first and second 
molars of the upper jaw were the same. It was very 
evident that this mass of caries was producing great 
irritation in the surrounding structures. 

When the diseased teeth were sounded with a steel 
instrument, the paroxysm of pain recurred with its 
usual violence. We immediately removed the two 
bicuspids and two molars of the lower jaw, and 
ordered the following : 



NERVOUS AFFECTIONS OF THE FACE. 153 

Acetate of Morphia, a quarter of a grain ; 
Camphor Mixture, an ounce and a half. 

To be taken as a draught : Also this aperient : 
Compound Extract of Colocynth, 6 grains. 
Calomel, 2 grains. 

Make into two pills ; to be taken at bed-time. 

These measures produced considerable relief, and 
in the course of a week the patient was so far reco- 
vered from the effects of the operation as to have the 
other diseased teeth removed, viz., the dentes sapi- 
entise of the lower jaw, and the first and second 
molars of the upper jaw. 

The morphia draughts were continued for a few 
days, and ever since the patient has had no return of 
pain. A few months since we had the satisfaction of 
hearing that she was quite recovered, and had not 
experienced a moment's uneasiness in the jaw since 
the last operation. 

The following case was sent to the Author by 
Mr. A. Kay, and presents a somewhat different 
character, although it is worth remark that it too 
had been mistaken for neuralgia. The effects of our 
local treatment are conveniently presented in the 
letter we received from the husband of the patient. 

" Sir. — My wife promised to let you know the 

h 3 



154 NERVOUS AFFECTIONS OF THE FACE. 

result of the operation you performed on her, of ex- 
tracting ten diseased teeth, and of opening the ab- 
scess formed underneath ; and certainly a most for- 
midable operation it was for a person in her delicate 
state of health. Soon after her arrival here, she 
experienced considerable pain and soreness in her 
mouth, which I attributed to her travelling in the 
cold. She was somewhat discouraged in consequence. 
In a few days, however, the violent paroxysms she 
had hitherto suffered from, gradually abated, and she 
is at the present moment free from pain. Her gene- 
ral health is much improved, and she now feels satis- 
fied that she took the proper step, as, though she has 
lost her teeth, she has gained what she values far be- 
yond them, namely, ease, comfort and health. The 
gums are not quite healed yet, but appear perfectly 
free from disease, with the exception of that part 
around the two front teeth, which are much decayed, 
and which you said she would be obliged to have ex- 
tracted, if any pain or uneasiness in the face returned. 
Thanking you for your kindness and attention, 
" I am, Sir, yours, &c, 

"B. White. . 



" Chapel Street, Halstead, Essex, 
"April 7th, 1845." 



CONSULTATION WITH MEDICAL PRACTITIONERS. 155 

In October this lady was well, and had experienced 
no return of pain. 



CONSULTATION WITH MEDICAL PRACTITIONERS. 

The dental practitioner occasionally meets with 
cases of so complex a nature, and so dependent upon, 
and bound up with, the state of the general health, 
that it is questionable whether the disease of the 
teeth has caused the general derangement, or vice 
versa; and consequently whether the case belongs 
to the dentist or to the physician. Other cases again 
occur of a mixed kind, in which the services of both 
the professions equally are demanded at one and the 
same time. 

In all these instances it will be well to remember, 
that where an individual selects a branch of the 
profession for especial practice, he would do wisely, 
whatever his talents or education, not to interfere 
with medicine at large, but to confine himself to that 
department which he has adopted. For if the dentist 
is presumed to be a more accomplished practitioner 
of his art because he limits his energies to it, by 



156 CONSULTATION WITH MEDICAL PRACTITIONERS. 

parity of reasoning, he must lose in reputation by 
overstepping that particular walk, and interfering 
with the duties of the physician or surgeon. 

In general diseases, then, and more particularly 
those connected with first dentition, in which there 
is great constitutional derangement, the dentist 
should urge the necessity for consultation with a 
medical man. A person unacquainted with the de- 
tails of the subject, would scarcely imagine the ad- 
vantages that the patient may derive from this course, 
or how greatly the two practitioners may assist each 
other in forming a correct diagnosis. And although 
there are in all callings some of those whom a learned 
physician has happily denominated " omnipotent 
practitioners," yet the world will have but a slight 
opinion of the dental skill of one whom they find 
prescribing for every class of ailments to which the 
human body is liable, and at all opportunities exceed- 
ing the art he professes to practice. 

" Ne sutor ultra crepidam," therefore, is an excel- 
lent motto, which we recommend to all our brethren, 
in the confidence that the maintenance of that divi- 
sion of labour on which dentistry is founded, and on 
which its recent advancement depends, is essential 
to the future welfare of the art and its cultivators ; 



CONSULTATION WITH MEDICAL PRACTITIONERS. 157 

being required alike by science and respectability, as 
well as by considerations of sound policy regarding 
the relations between dentistry and the other allied 
professions. 



CHAPTER XIV. 



VALUE AND IMPORTANCE OF THE TEETH AS 
CONNECTED WITH HEALTH, ETC. 

Having pointed out as concisely as possible the 
various diseases to which the teeth are subject, and 
the modes of treatment, we shall now give a brief 
summary of the relations that these organs and their 
functions bear to health, comfort, personal appear- 
ance, and enunciation or speech. 

And first as regards health. Before the food is 
taken into the stomach, it is necessary that it be 
comminuted, and mixed with a portion of saliva, so 
that afterwards it may be regularly and perfectly ex- 
posed to the action of the gastric juice.* Now the 

* " It is estimated that about six ounces of saliva are secreted 
during the average time of a meal. It flows in greater quantity when 
the food is acrid and stimulating. It mixes with the mucus copiously- 
secreted from the glands, and with the serous fluids exhaled by the 
exhalent arteries of the mouth. There can be no doubt that the 
saliva, mixing with the food by the motion of the jaws, absorbs 
oxygen, and unites to the alimentary substances a quantity of that gas 
fit to bring about the changes they are ultimately destined to undergo." 
(Richerand's Physiology, p. 96.) 



VALUE AND IMPORTANCE OF THE TEETH. 159 

teeth are the instruments by which this comminution 
is effected. Perhaps we cannot better illustrate the 
importance of the process, than by comparing the 
human teeth with those of the different classes of 
animals that feed on vegetable matter, and are either 
graminivorous, or herbivorous, or both. Let us, for 
this purpose, take the cow as an example. 

This animal feeds hastily; to balance which cir- 
cumstance, nature has provided it with more than a 
single stomach or receptacle for food. The stomach 
into which the food is first taken, has the power of 
returning it to the mouth, there to undergo a second 
and more perfect mastication, called rumination, or 
in common language, chewing the cud. After this 
the mass is fit for the true stomach, where its conver- 
sion into nourishment commences. 

In animals of this class, the incisors or cutting 
teeth are thin and sharp, whereby they are enabled 
to crop the shortest grass, and to fill the stomach 
quickly; while the molars have large surfaces for 
effectually grinding the food when submitted to their 
action. 

An equal necessity for perfect mastication exists 
in man, and thus the teeth, on which this depends, 
ought of course to be in a sound and healthy state. 
In fact, the provision that nature maintains for 



160 VALUE AND IMPORTANCE OF THE TEETH. 

animals, cannot be impaired in human beings with- 
out interfering with their bodily health and comfort. 
When the teeth are imperfect, the food cannot be 
either properly comminuted, or thoroughly mingled 
with saliva. The consequence is, as we before hinted 
(see page 1), that the sense of taste is very imperfectly 
exercised upon the nutrient materials, when yet this 
sense is in a manner stationed as an outward guard 
over the whole series of digestive apparatus. For com- 
mon experience shews, that while objects remain of a 
certain size, they are amenable only to the sense of 
touch, but not to that of taste, which is a finer or 
more particular touch, and requires a minuteness in 
its objects before it can appreciate them. This we 
all know from the fact, that pieces of food when 
first taken into the mouth, though felt by the lips, 
tongue, &c, are hardly tasted at all, but that they 
yield their taste precisely in proportion as the teeth 
act upon and reduce them. The analytic operation 
of the teeth is, therefore, so far as solid bodies are 
concerned, the needful precursor of gustatory sensa- 
tion. This operation is, on this account, one of the 
highest administrative offices that the teeth perform 
in the animal economy, without which the food 
would intrude itself in gross morsels into the sto- 
mach, and give rise to another evil consequence than 



VALUE AND IMPORTANCE OF THE TEETH. 161 

that of deficient gustatory sensation, viz., indigestion, 
with its concomitant evils.* Moreover if the first 
part of the digestive process be not properly per- 
formed, the succeeding ones will be imperfect ; and 
all this, because the teeth are defective. f 

We have said that the teeth enable the food to be- 
come an object of the sense of taste, and it is equally 
true that they themselves are the sensories, or, at all 
events, the transmitters, of a fine and peculiar sense 
of touch. To be convinced of this we have only to 
recollect the pleasurable feeling associated with the 
comminution of many substances, some of which 
have but little taste, as nuts of all kinds, &c, &c, 
which have a singular effect upon the teeth. This 
sense appears to be something intermediate between 
touch and taste, and to explore the food by a middle 
feeling between that of the lips and that of the 

* L. S. Parmly, Lectures on the Natural History and Manage- 
ment of the Teeth, p. 21. 8vo., London, 1820. 

f Dr. Fitch attributes dyspepsy or indigestion to a diseased state of 
the teeth, preventing a proper mastication of the food ; and to the 
ulcerated and putrid matter which passes from the teeth and gums, 
along with the aliment, to the stomach. He also says that the 
irritation produced by diseased teeth is often so great as to disturb 
the healthy functions of the system, and of the stomach in particular. 
(On the Teeth, p. 308.) 



162 VALUE AND IMPORTANCE OF THE TEETH. 

tongue. Its existence is often disagreeably proved 
by small pieces of cinders, little stones, gnd the like, 
coming between the grinding surfaces of the teeth, 
and which are most nicely apprehended by those 
organs. 

It will not be disputed that perfection or imperfec- 
tion of the teeth makes the greatest difference in the 
personal appearance of the individual. The loss of 
even a single front tooth spoils the symmetry of the 
mouth ; but when the whole are gone, and the al- 
veolar processes absorbed, two or three inches are 
taken from the length of the face ; the nose and chin 
approximate ; the skin runs into huge gathers and 
deep furrows ; the cheeks protrude, the mouth loses 
its smile, and under these circumstances, the sweet- 
est face becomes senile and deformed : we will not 
say ugly, because if the mind be well disposed, its 
amiability will still shine forth from the ruins of the 
physiognomy. 

The accompanying engravings represent the same 
face with and without teeth. 

Furthermore, the teeth are of great importance as 
organs of articulation ; not less so indeed than the 
lips and tongue, which act in unison with the teeth 
in speech ; the vibration of the tongue especially, as 
it strikes against the teeth, producing many of the 



^ I 




With bh&Tis&bk. 

7'hp rim* nfher/n. 



VALUE AND IMPORTANCE OF THE TEETH. 163 

sounds of the human voice. This office of the teeth 
is well remarked upon by Aristotle, who says that 
" the character and number of the teeth in man are 
mainly ordered with a view to speech/' and that "the 
front teeth contribute in a remarkable manner to the 
utterance of several of the letters of the alphabet."* 
To demonstrate this experimentally, the reader has 
only to pronounce the words, " the," " therefore," 
"those," "they," or "that," and he will perceive 
the vibratory action of the tongue against the teeth, 
and the manner in which the lips modulate the 
sound, and give it definite expression. Or again, he 
may observe the same words when uttered by persons 
who have lost their front teeth ; when the effect will 
be found to resemble that which would be produced 
by a person speaking through a wooden tube. 

And as the teeth contribute to the articulation of 
the voice, so they also transmit the voice to the ear 
of the individual uttering it, and give a loudness 
and distinctness to the sound as apprehended both 
by the internal and external auditory passages. This 
is readily proved by the familiar experiment of hold- 
ing a poker between the teeth, having previously 
closed the ears, and applying the other end of the 
poker to a boiling kettle ; in which case the sound of 

* " De Partibus Animalium," lib. iii., cap. i. 



164 VALUE AND IMPORTANCE OF THE TEETH. 

the ebullition is conveyed through the teeth to the 
ear and head with the greatest clearness. It is im- 
possible to do other than conclude from this, that 
whatever sounds strike upon the teeth, are at once 
conveyed by them to the ear, and perhaps to the 
whole cranial sounding board. And this may be one 
reason why those who are deaf, open their mouths 
to catch sounds by way of the internal ear : an action 
which is generally referred entirely to the presence 
in the mouth of the Eustachian tube, but which we 
are inclined to think depends also upon an instinctive 
feeling of the manner in which the teeth carry sounds 
to the auditory organs. 

Hence it is that disagreeable sounds are said to 
" set the teeth on edge a fact respecting which 
many curious idiosyncrasies are observable. The 
husband of one of our patients is almost distracted, 
and exclaims that " his teeth are coming out of his 
head," if paper be creased by the nail in his pre- 
sence ; and others are affected in the most painful 
manner by the sound of cinders under the fire-shovel, 
&c, &c. : clearly proving that the teeth perform some 
universal offices as transmitters of sound ; and which 
indeed are proverbially though not yet physiologi- 
cally recognized ; for common sense runs faster than 
science. 



VALUE AND IMPORTANCE OF THE TEETH. 165 

Such are a few of the wide offices of those humble 
and sometimes despised and neglected organs, the 
human teeth. Themselves organs of sensation, they 
contribute indispensably to the sensation of the next 
higher organ in the same series, viz., the tongue. 
And by the same act, we mean the comminution of 
the food, they perform what may be called the first 
digestion, which is necessary to the proper perform- 
ance of the second digestion, or that of the stomach. 
Moreover, they build the face into beauty in woman 
and manliness in man ; wonderfully completing both 
the softness of the feminine expression, and the firm- 
ness of the male. And if they give beauty to the 
face, they are also beautiful themselves both in form, 
colour and lucidity, so that the poets have well lik- 
ened them to pearls, and spotless ivory and alabaster. 
Nay, their uses are higher or more intellectual still, 
for they have a share in forming the voice, which is 
the distinctive of the one being who is endowed by 
the Creator with a will and understanding ; and thus 
they stand in that series of mechanism which brings 
the intellect into physical expressions, and enables 
man to converse with man, and to institute societies ; 
which enables the orator and the preacher to guide 
and sway the minds of others ; which utters truths, 
and communicates affections. Lastly, they contri- 



166 VALUE AND IMPORTANCE OF THE TEETH. 

bute to give the speaker himself a clear hearing of 
his own voice, and thus to bring down self- conscious- 
ness into the lowest sphere, and to enable us to ac- 
quire intonation, and the utterance of our thoughts, 
with the greatest perfection. 

All these uses clearly demonstrate that the teeth, 
like the body and its organs generally, are a trust, 
for the proper maintenance and administration of 
which we are deeply responsible : they also shew, that 
by regarding the teeth from the purposes they serve, 
we may have higher views of them, and appreciate 
their importance more correctly, than could be the 
case if we based our induction simply upon their^ 
anatomy, physiology, and microscopic characters ; 
neglecting the broad and common-sense facts we 
have stated above. Wherefore although we justly 
value the contributions of the anatomist to dental 
science, yet we hold that the eyes of the anatomist 
and microscopist require to be armed by a recog- 
nition of the great and practical effects which the 
teeth produce ; after which they will be more compe- 
tent than now to look upon many knotty questions, 
such as the organization of the enamel, &c, &c, &c. 
Let us not then neglect the broad features of our 
case, which are, after all, the most instructive, and 
the most nearly allied to the practice of our art. 



( 167 ) 



THE MEANS OF PRESERVING THE TEETH. 

Notwithstanding the considerations adduced in the 
preceding section, and with the main details of which 
almost every one is acquainted, yet few persons are 
induced to acquire that easy knowledge which is 
necessary to effect the preservation of the teeth, or 
if they do acquire it, few are found to follow it up 
with the diligence requisite to success. Probably 
they so far sacrifice to cleanliness as to brush their 
teeth once a day, but having done this, and being 
satisfied that the teeth perform their duties for the 
present, no pains are taken to ensure their services 
for a prolonged future, or to prevent them from fall- 
ing into a dilapidation which renders them worse than 
useless. Too often, for instance, a dentifrice is used 
that makes the teeth white for the time, but at the 
expence of tooth-ache and decay in the time to come ; 
or tartar is allowed to accumulate, or the beginning 
of caries is neglected, &c, &c. Were it possible for 
us to impress upon the public the importance of care 
and attention to the subject, to cause them to avail 
themselves of proper precautions for the preservation 
of the teeth, and to convince them of the need there 
is for a periodical visit to the dentist, we are sure 
that a large amount of pain and misery would be 



168 MEANS OF PRESERVING THE TEETH. 

avoided, and many teeth would last for life which 
are at present sacrificed before manhood even com- 
mences. 

The reluctance commonly felt by patients to apply 
to the practitioner, is, we admit, unfortunately 
grounded in many cases upon a knowledge of the 
unprincipled acts of some of those usurious pre- 
tenders who disgrace the dental profession. Nume- 
rous individuals are afraid, and not without justice, 
to place themselves under the dentist ; they have 
perhaps had sad experience already of the u tender 
mercies " of a certain class of operators, or they have 
heard accoimts, too authentic to be doubted, of 
suffering and injury undergone by their immediate 
friends and relatives. Thus the whole profession 
(and with it the public) suffers for the improprieties 
of a few of its members ; and a benign art becomes 
a bugbear to those whom it is intended to benefit. 
Nothing can altogether remedy this but an improve- 
ment in the profession itself, by which it shall purge 
itself of that dross which it at present contains. In 
the meantime we beseech the public not to throw 
away a real good because it has been abused, but to 
be more than ever careful in the choice of their den- 
tist, valuing character more than either cheapness or 
notoriety. If they do this, they will have in their 



MEANS OF PRESERVING THE TEETH. 169 



own hands the power of commanding justice and 
skill whenever they require them. 

Actual pain is too frequently the only thing that 
will compel the patient to apply to his dental ad- 
viser, and many a valuable tooth is ruined on this 
account. For the teeth differ somewhat from other 
organs, insomuch that in them disease may have 
made considerable progress before pain is urgent. 
So long as decay is confined to the enamel and bone, 
the patient is not aware of the ravages that are going 
on, and probably not till such decay has destroyed 
the bony substance, and exposed the internal cavity 
of the tooth, is his attention called to the subject. 

We advise that children should be early habituated 
to take care of their teeth, in order to ensure proper 
attention to them in after life.* At five years old 
they may begin to use a tooth-brush, which should 

* " It is a religious precept," says Tournefort, in his ' Voyage to 
the Levant,' " among the Mussulmen, to make a little ablution with 
the face turned towards Mecca ; to rinse the mouth thrice, and clean 
the teeth with a brush. This shews how highly this custom is 
esteemed among a people, who formerly were forbidden, according to 
Menavius, to have a tooth extracted without permission from the 
emperor. Let children be taught by their parents the proper degree 
of care necessary for their teeth ; they generally imitate them even in 
their sports ; here the agreeable lesson will be converted into a useful 
habit." (Duval, The Dentiste de la Jeunesse, translated by Atkinson, 
p. 75 ; 8vo., Leeds, 1820.) 

I 



170 MEANS OF PRESERVING THE TEETH. 

be employed at least once a day. This brush must 
be of middling firmness, two degrees harder than 
goatVhair. 

Particular regard should be paid to the grinding 
surfaces of the double teeth as they make their ap- 
pearance in the mouth, for their unevenness often 
causes them to retain particles of food, and thus 
makes them very subject to decay. These teeth re- 
quire a rather hard brush with long elastic bristles, 
which should be used after every meal, to remove 
any remains of animal or vegetable matter before 
decomposition commences. 

The lateral edges and posterior surfaces of the 
teeth also require great care, as particles of food and 
deposits of tartar are apt to lodge between them. 
To cleanse these parts effectually, the brushes must 
be moved not only across the teeth, but upwards and 
downwards, confining the action to no one particular 
direction. 

The annexed representation shews a brush intended 
for the lateral edges, anterior surfaces and crowns of 
the teeth. 



MEANS OF PRESERVING THE TEETH. 171 



The following is a brush suited for the posterior 
surfaces of the incisors and upper centrals. 




The bristles ought to be sufficiently long and elas- 
tic to penetrate into the interstices between the 
teeth!;, The opinion that using a brush with this in- 
tent removes the gums from the necks of the teeth, 
is erroneous ; the fact being, that where the gums 
are relaxed, spongy, and liable to bleed, the above is 
one of the best means of restoring them to healthy 
action, and causing them to adhere more firmly. 

As we before observed, the teeth should be cleaned 
and brushed after each meal, using either the Quinine 
Dentifrice, camphorated chalk, or a powder composed 
of the following : 

Orris root, \ ounce, 

Gum -myrrh, J ounce, 

Nutmeg, finely powdered, 1 scruple, 

Chalk, 1 ounce. Mix. 
These tooth-powders should be used at least once a 
day, the best time being in the morning. Occasion- 
ally the gums should be brushed with a little spirits 

i 2 



172 MEANS OF PRESERVING THE TEETH. 

of camphor or eau-de-Cologne, which may be dropped 
on the brush, and applied after the tooth-powder. 

In cases of irregularity it may be difficult to 
keep the teeth clean by means of a brush alone : and 
the end may then be answered by a piece of cane de- 
prived of its bark, and cut to the shape of a wedge, as 
represented in page 124. This will be found available 
in situations that are not to be reached by a brush. 

Those who wish to preserve their teeth should on 
no account use a metallic tooth-pick. If it be neces- 
sary to use one at all, those made of quill, and sold 
at the stationer s' shops, are the only safe ones. 

When the gums are tender, or the teeth loose, the 
astringent lotion before referred to (page 134) should 
be used twice or thrice a day, in the proportion of 
half a teaspoonful to a wine glassful of warm water. 

Thus the means of preserving the teeth are few 
and simple, and yet if fully acted upon, they will be 
found to be efficacious. Cleanliness, in one form or 
another, embraces them all. Is it too much to re- 
quire this of civilized people, who would be shocked 
at the necessity for the recommendation if it applied 
to their hands, faces, or other parts of their persons ? 
This much we will say, that the attention which is 
paid to cleanliness, of the teeth especially, is in exact 
proportion to the civilization of the individual, or to 



ARTIFICIAL TEETH. 



173 



his height in the social scale. If his teeth are green, 
brown and stinking ; if they are embedded in tartar, 
or half eaten up by caries, his feelings must be blunt 
indeed if he can go into society without knowing 
that he is an outrage in the eyes and noses of his 
acquaintance. The morale of such a person requires 
serious correction. As " cleanliness is next to god- 
liness," so his uncleanness is akin to considerable 
perversity. Let him by all means mend his manners ; 
apply to his dentist to have his teeth set right ; be- 
stow due pains afterwards to keep them right ; and 
bring up his children, and influence his friends, to 
follow well the path of dental rectitude. 

In conclusion it may be observed, that the food of 
the upper and middle classes, which is generally rich, 
and therefore liable to offensive decomposition, nay, 
which is often partially decomposed when it comes to 
table, necessitates far greater attention to keep the 
teeth clean, than the simple fare of the labouring 
family. 



ARTIFICIAL TEETH. 

We have hitherto endeavoured to point out, by a 
variety of considerations, the necessity of retaining 
the teeth in the mouth as long as possible, and we 
have suggested all the means we are aware of, to 



174 



ARTIFICIAL TEETH. 



keep them in health, and also to renovate them arti- 
ficially after disease has actually taken effect. Often, 
however, notwithstanding the precautions of the pa- 
tient, and the best efforts of the dentist, these orna- 
ments of the hnman face are prematurely lost or 
destroyed, and mastication, the dignity or beauty of 
the face,* and the perfection of the voice, seem to 
be gone beyond recall. What is to be done under 
such afflicting circumstances? Is the dental art 
beneficent enough to furnish a substitute for these 
invaluable organs ; a remedy against the annoying 
and sad consequences of their removal from the 
mouth ? Are health, beauty, and utterance indebted 
to it for so great a boon ? Artificial teeth are the 
answers to these interesting questions. 

It is right however to warn the patient, that under 
no circumstances will artificial teeth be equal in use 
to those given by nature; for the sense of touch 

* For the mouth is not the only feature impaired by the loss of the 
teeth : all the other parts of the countenance become more or less dila- 
pidated. The nose loses its support ; the face, from the forehead down- 
wards, is shortened, and its natural beauty destroyed. A deep pit is 
formed under the cheek-bone ; the lower jaw is drawn upwards, and the 
lips inwards ; for the fibres of the principal muscles of the face change 
their oblique direction, and run into the mouth nearly at right angles. 
Moreover, from the absence of that fulcrum which the teeth afforded 
to other and antagonist muscles, wrinkles are distributed over the 
whole surface, completing the picture of deformed and decadent age. 



ARTIFICIAL TEETH. 



175 



cannot exist in the former ; so that the same modi- 
fied sensations are not conveyed by them to the 
nervous system as the teeth themselves never fail to 
convey. We think it right to state thus much in 
limine; because the extravagant pretensions which 
are sometimes made in dental advertisements, and 
which cannot be realized, tend to bring artificial teeth 
into discredit, and to prevent the public from reaping 
the true advantages which they are able to afford. 

Although then artificial teeth have not the quali- 
ties which some dentists profess, yet it is surpris- 
ing how comfortable and beneficial they may prove, 
and how thoroughly, if well adapted, they may serve 
the purposes of mastication and enunciation. 

No department of the dental art has afforded so 
much scope for quackery and extortion as the pre- 
paration of artificial teeth, and on none has there 
been more ingenuity and real labour bestowed with 
such questionable success. 

The perfection of artificial teeth depends, firstly, 
on their being so skilfully adapted to the mouth that 
they may be worn with perfect ease and convenience. 

Secondly, on the manner in which they are fast- 
ened in the mouth ; for the ligatures frequently em- 
ployed to fasten them, loosen and destroy the ad- 
jacent teeth. 



176 



ARTIFICIAL TEETH. 



Thirdly, on the suitableness of the materials em- 
ployed in their construction ; for improper materials 
cause irritation of the gums, ulceration and slough- 
ing of the soft parts ; effects that are by no means 
unfrequent from the employment of gold with a 
large alloy of copper, of silver, pinchbeck, gilded 
brass, &c, &c. 

Fourthly, on such an adjustment as will give 
solidity and firmness, and on such a close adaptation 
as will prevent the lodgement of food between the 
artificial material and the gum ; by which, if it took 
place, a taint would be imparted to the breath. 

Having given an outline of the conditions on 
which the success of artificial teeth depends, we 
shall now proceed to speak of the various kinds of 
them employed, and of the basis on which they are 
fixed ; for one kind of tooth or base is not adapted 
for every case ; since the health of the patient, the 
state of the gums, irritability of temperament, the 
chemical qualities of the saliva, &c, &c, are each 
modifying circumstances which demand the attention 
of the dentist, and by a proper consideration of 
which only, he can ensure success, and comfort to 
the patient. 

Whenever a tooth is lost, its place should be sup- 
plied, as soon as possible, by an artificial one, so 



ARTIFICIAL TEETH. 



177 



constructed as to support the adjoining teeth, and to 
preserve the contour and symmetry of the face. 

We commence our enumeration of the different 
kinds of artificial teeth, with the human tooth. These 
have been long in use, and are generally set on a 
gold base or palate plate, or in sockets made of the 
tusk of the hippopotamus (i.e. dentine), or occasion- 
ally of that of the walrus, which are accurately fitted 
to the gum on which the teeth are placed. Each of 
these plans answers excellently in particular cases. 

The next kind is the tooth of the hippopotamus 
shaped to resemble the teeth, with the natural cover- 
ing of enamel left on. 

This kind of teeth is objectionable, as the enamel 
presents an unnatural whiteness at first, which soon 
changes in the mouth to a light transparent blue, 
and affords altogether a bad imitation of the natural 
teeth. 

The same substance, shaped into the form of teeth, 
is also used with the enamel removed ; but if it be 
of inferior quality, a few weeks use only is required 
to destroy its natural whiteness, and few months 
will have passed before it bears a striking resem* 
blance to Honduras mahogany. 

These are the cheap teeth commonly advertised at 
j£5 and £10 a set j the tooth of the walrus, which is 

i 3 



178 



ARTIFICIAL TEETH. 



of still inferior quality, being in many cases substi- 
tuted for hippopotamus. 

Besides the substances above described, artificial 
teeth are also formed of a kind of fret ; a vitreous 
substance similar to that used for glazing china at 
the potteries. Various mordents are mixed with this 
substance to give it the different tinges of the human 
teeth, which it then resembles with an exactness that 
it would be impossible to give an idea of. The teeth 
constructed of it are fixed on gold, or in the ivory 
of the hippopotamus, in the same manner as human 
teeth. Those who are further curious on this subject 
may refer onwards to our mechanical treatise for a 
more full explanation. 

These teeth possess great advantages over all other 
artificial teeth. They neither decay, change, nor are 
in any way affected or acted on by the juices of the 
mouth or by acid medicines. Moreover they are 
especially enduring. They are liable, however, to one 
objection. In short cases, where the approximation 
of the jaws is such as not to admit a sufficient sub- 
stance of tooth at the back to resist pressure, they 
are liable to fracture; and if this happens to the 
patient when at table or in company, it places him of 
course in no very enviable predicament. 

They are now manufactured in this country by 



ARTIFICIAL TEETH. 



179 



many persons, who supply the dentists : they are also 
imported in immense numbers from Brussels; and 
are advertised under various names, as, " Incorrodible 
Teeth," " Silicious Mineral Teeth," "New Inven- 
tion Mineral," &c, &c, &c. ; all of which are one 
thing under many names. 

Another description of teeth, called the French 
Mineral, has long been in use in this country. These 
are admirably adapted for short cases in which the 
former kind is liable to fracture. 

Great improvements have been made within a few 
years in the structure of these teeth. Formerly they 
were indeed artificial as contradistinguished from 
natural; for they resembled real teeth neither in 
shape nor colour. Now they are made of exquisite 
beauty and correctness. 

In cases where it is necessary to supply defi- 
ciency of structure arising from absorption of the 
alveoli, these teeth are manufactured with an ar- 
tificial gum. They are chiefly prepared by Mr. 
Stockton, of Philadelphia, U.S., who has brought 
them to the greatest perfection. But from their 
being little known to dentists, they are not in gene- 
ral use in this country. 

From the foregoing observations it may be gath- 
ered, that there is no particular kind of teeth adapted 



180 



PIVOTED TEETH. 



for every case ; for all inorganic substances undergo 
more or less decomposition in the mouth according 
to the vitiation of the saliva ; and each mechanical 
case that presents itself to the dentist, gives a dif- 
ferent approximation of the jaws, so that it becomes 
necessary to adapt the teeth to the mouth, and not, 
as some dental conjurors would persuade us, the 
mouth to the teeth. It is absurd to suppose that 
one kind of teeth will suit all mouths. The practi- 
tioner of our art should always keep this in mind, 
and follow nature with pliant skill ; making use of 
those materials that are best adapted to the comfort 
of each patient in the several departments of masti- 
cation, enunciation, and personal appearance. 



PIVOTED TEETH. 

The operation of pivoting teeth may be said to 
have originated out of one of a more questionable 
character suggested by John Hunter, — I allude to 
the transferring of a tooth from one person's mouth 
into that of another, — an operation that was per- 
formed with various results, but which under any 
circumstances was revolting, and sometimes also dan- 
gerous, inasmuch as serious diseases were thereby 



PIVOTED TEETH. 



181 



transplanted with the tooth, and the dentist became 
chargeable with aggravating the ills that flesh is 
heir to. 

The operation itself was simply what we have 
stated ■ the transplanted tooth being retained in situ 
until it grew fixed. It produced so many ill effects, 
and was found so inefficient in result, that it soon 
fell into desuetude, and the operation of pivoting 
arose out of its ashes. 

This operation is confined to those teeth that have 
single fangs, and indeed is seldom performed on any 
but the front and canine teeth. When caries has so 
far destroyed the crown of these teeth that it is im- 
possible to stop them, and they present an unsightly 
appearance in the mouth, the remains of the crown 
are either filed or cut off, and the natural canal of the 
fang taken advantage of, for the insertion of a gold 
pin, to which a crown of the exact size, shape and 
colour of the remaining teeth, is fixed and fitted ; 
the gold pin being forced into the natural opening, 
and retained there by means of mastic varnish and 
silk. This operation requires care and judgment to 
prevent subsequent inflammation and swelling of the 
face, particularly in nervous and irritable patients. 

The parts themselves and the general system should 
be prepared for the operation by local bleeding, or 



182 



PIVOTED TEETH. 



else this should be resorted to immediately after- 
wards, in order to allay inflammatory action ; other- 
wise the most excruciating suffering may follow, with 
eventual loss of the fang from suppuration. Arti- 
ficial teeth, when properly fixed in this manner, have 
been known to last thirty and forty years without the 
slightest inconvenience or discolouration. The ac- 
companying wood- cut represents a front tooth en- 
grafted by the late Mr, Waite, and which the patient 




had in his mouth for thirty years, and then lost by 
absorption of the fang ; through the end of which, 
the gold pin to which the crown is attached is here 
seen protruding. 



PART II. 



MECHANICAL DENTISTRY. 



PART II. 



MECHANICAL DENTISTRY. 

INTRODUCTORY REMARKS. 

It is certainly remarkable, as we said above (pp. 1, 2), 
that while in this country there are many excellent 
works on dental surgery, there should not be even 
so much as one on the mechanical branch of the pro- 
fession ; and the more so, as our brethren in America 
have already communicated to the world a mass of 
sound information upon this necessary and useful 
department of the dental art.* 

The causes of our deficiency in this respect are 
various. 

Foremost among these is the fact, that dentistry 
is too often separated from mechanics ; and that the 
dentist is only very partially informed concerning the 
lower processes of his art, upon which, however, so 
much of its success depends. Thus the artizan and 

* To the ingenious and scientific Dr. Brown, of New York, I am 
indebted for the method of fixing, &c, the American mineral teeth. 



186 



INTRODUCTORY REMARKS. 



mechanic has become in many cases the sole deposi- 
tory of a knowledge that his employer, the dentist, 
ought, of right, to be thoroughly acquainted with. 
The knowledge, therefore, has remained traditional, 
and the art of printing has not yet reached it in 
England. Many other branches of practical science 
are in the same condition, and have not hitherto had 
the benefit of the daylight and free air afforded to 
every subject by the printing-press. 

This state of things it is our hope to remedy. For 
it must be remembered that the art of dentism is 
essentially mechanical, and that for this very reason 
it has been constituted a separate branch of practice j 
so that no man can be considered an accomplished 
practitioner who is not to the same extent a me- 
chanic, both theoretically and practically. For put- 
ting out of sight the adaptation of artificial work to 
the mouth, which will occasionally draw largely on 
the knowledge, ingenuity, and experience of the 
practitioner ; even the every-day operations of stop- 
ping, scaling, filing and extracting, cannot be well 
or safely performed by any but one who is versed in 
the laws and resources of mechanics. 

The whole art of dentism is so intimately con- 
nected with mechanics, that a man may be a good 
anatomist, physiologist, and pathologist, yet, unless 



INTRODUCTORY REMARKS. 



187 



he be at home in the science and manipulations of 
mechanics, — unless he be mechanically-minded and 
mechanically-handed, — he must necessarily be a bad 
dentist ; nay, however well he may write prescrip- 
tions and give advice, he must practice his art with 
disadvantage both to himself and to his patients. 

We are aware that many dentists consider the 
mechanical branch of the art as beneath professional 
dignity, and some even pride themselves on their 
ignorance of what is the greatest aid to practice. 
The latter are men whom we cannot hope to con- 
ciliate, and for whom real and correct knowledge 
exists in vain. We are well content to bear their 
strictures, and we appeal from them to the good 
sense of the public, of the medical profession gene- 
rally, and of all the most enlightened practitioners of 
the dental art. 

We feel that secrecy is in no way necessary to the 
success of our calling ; that by divulging with honest 
freedom whatever we know, we strike the most effec- 
tual blow against fraud and quackery, at the same 
time that we expose the knowledge for which we are 
indebted to our ancestors and to our own minds, to 
that wholesome action of public opinion, by which 
gradually error is sifted away, truth made brighter, 
invention added to and improved, complex things 



188 



INTRODUCTORY REMARKS. 



simplified, and the basis of all arts widened, until at 
length their benefits become available to the great 
mass of the people. And if at any time we have 
spoken with enthusiasm of our art, it is because we 
are devoted to it with sincere admiration. In it, as 
in a perfect though minute mirror, we contemplate 
the whole of surgery : it is the most definite, pre- 
cisely because it is the most mechanical, of the heal- 
ing arts : it in a manner embraces them all ; and in 
proportion as it is perfected, it must become an illus- 
tration and example of the pitch to which medico- 
chirurgical science generally ought to endeavour to 
attain. 



MECHANICAL DENTISTRY. 



The art of mechanical dentistry consists in the con- 
struction and adaptation of sets, and parts of sets, 
of artificial teeth ; in the application of mechanical 
means for the correction of irregularity of the teeth ; 
in engrafting or pivoting artificial crowns of teeth on 
the natural roots that remain in the mouth ; in con- 
structing artificial palates ; in taking impressions or 
models of the gums, and of deficiencies of the teeth ; 
in casting ; making plates ; soldering ; fitting bone ; 
inserting teeth in bone; filing; polishing; besides 
many other branches, which it is our intention to ex- 
plain in the following treatise in such detail as is 
necessary for practice. 

We shall presume that the student is provided 
with a work-bench, and lathe attached, similar to the 
one here represented, the size of which is 24 inches 
in length by 12 in breadth, and 33 in height; while 
around the upper board or table, at the edge, is fixed 
a small beading, A, to prevent the tools, &c, from 
falling off. From the centre of the plank, B, is cut 



190 



MECHANICAL DENTISTRY. 



a segment of a circle, which is intended to admit 
the chest of the workman ; and in the middle of this 
segment is morticed a bench-pin, C, to be used for 
filing teeth, gold pins, &c, upon. Underneath this 



MECHANICAL DENTISTRY. 



191 



pin is a drawer, D, in which is placed a false bottom, 
E, made of finely -perforated zinc, with a handle on 
each side for its removal. It serves the purpose of 
collecting and separating the gold. Underneath this 
again is suspended a skin of leather on the hook, F, 
as a precaution against the loss of any gold filings 
that may escape the drawer, D. On the right-hand 
side are several drawers, G, for containing teeth, 
drills, sculpers, gold files, &c. Above these, on the 
top of the bench, is fixed a small oil-stone with 
cover. On the opposite side is attached a small 
lathe, H, with treadle, &c. On the bench are ex- 
posed a few of the implements employed in making 
artificial work, such as a bone rasp, hammer, sculper, 
pliers, round and half-round files, colour pot, &c. 

As we proceed, it will be necessary to describe and 
figure many other necessary implements used in me- 
chanical dentistry. 

Preparing Wax for Impressions or Models. — 
Impressions or models of the mouth are taken by 
means of bees' -wax, softened by immersion in hot 
water, and kneaded until it assumes the consistence 
of soft putty. The operation of preparing the wax 
has usually been performed by servants ; but as all 
operations connected with the mouth should be con- 
ducted with extreme cleanliness and nicety, we have 



192 



MECHANICAL DENTISTRY. 



invented an apparatus that not only facilitates the 
preparation of the wax, but makes the operation 
more agreeable to the patient, by obviating any un- 
pleasant suspicion of the wax having been manipu- 
lated by dirty hands. The following engraving re- 
presents this apparatus. 

It consists of a cylindrical outer case, A, made 
of thick block tin japanned, 12J inches in height, 
and 32 in circumference, and perforated at the top, 
B. Into this cylinder is fixed an inner vessel or 
boiler, 4 inches in depth, and 28 in circumference ; 



MECHANICAL DENTISTRY. 



193 



the bottom of it being indicated by the dotted line, 
CC. To this is made to fit accurately a moveable 
vessel, D, 3| inches in depth, and supported by a 
rim resting on the ledge, E ; the bottom of this 
second vessel is perforated in a manner similar to the 
common domestic steamer. The whole is surmounted 
with a cover, F. Within two inches of the bottom 
of the apparatus is a door, Gr, 5 inches in width, 
and 3| in height, in the centre of which is a small 
moveable ventilator, H. Underneath this door is a 
drawer, I, with two divisions, one containing lucifer- 
matches, the other covered by a piece of finely- 
perforated tin for igniting them. J is a tap inserted 
into the boiler, about a quarter of an inch from the 
bottom, for drawing off the water. On each side 
are handles, K. The apparatus is supported by three 
feet, and is 19 inches in height. 

The boiler is heated by a spirit lamp with three 
burners, and is supported on the inside of the outer 
cylinder by two pieces of tin, extending to the oppo- 
site side of the cylinder, with a stop for the purpose 
of keeping the lamp immediately in the centre of the 
boiler. The following represents the frame-work and 
lamp. 

A quart or more of water is poured into the boiler, 
with as much wax as may be required for taking the 

K 



194 



MECHANICAL DENTISTRY. 




impression : the lamp is lighted, and placed under- 
neath the boiler. Three or four minutes will be 
found sufficient to reduce the wax to the proper con- 
sistence ; if the heat be continued longer, the wax 
becomes too soft, and the impression is liable to 
injury in the act of withdrawing it from the mouth. 

Taking the Impression or Model. — Having 
prepared the wax as before mentioned, select a tray 
according to the annexed figure. This tray is usually 




made of silver or German metal. The operator 
should be provided with a number of such, varying 
in size, for taking an impression either of a single 



MECHANICAL DENTISTRY. 195 

tooth, or of a complete set. Haying chosen the proper 
size, and taken a quantity of the softened wax suffi- 
cient to fill the tray, the patient should now be 
desired to wash his mouth with cold spring water. 
This precaution against an imperfect impression is 
absolutely essential, particularly in cases where the 
natural teeth in the mouth have lost the support of 
their neighbours, and with it their perpendicular po- 
sition, and incline obliquely towards the centre. 
After this preliminary, at once insert the frame cau- 
tiously into the mouth, and press the wax perpen- 
dicularly and firmly against the cutting edges of the 
teeth in the part that you wish to fill with an artifi- 
cial substitute ; continue the pressure steadily, until 
the teeth and gums are completely embedded in the 
wax. When the required depth has been obtained, 
carefully press the wax against the inside gum and 
the fronts of the teeth. The frame must now be 
slightly tilted from behind, so as to loosen the wax 
from the back teeth ; a similar movement is required 
to disengage the wax from the fore-part of the mouth ; 
then gently withdraw the tray, taking care not to 
disturb or drag the wax, otherwise the impression 
will be imperfect, and the operation will require 
to be repeated. The following represents a perfect 
impression. 

k 2 



196 MECHANICAL DENTISTRY. 




When the wax has cooled, insert into each impres- 
sion of the patient's own teeth in the wax (as repre- 
sented) small pieces of thin iron wire of the following 
shape, to prevent the plaster cast receiving injury in 



removing it from the wax, or in the course of trying 
on the plates, fitting teeth, &c, on the model, during 
the process of manufacturing. 

For fastening particular kinds of artificial teeth to 
the plate, such as the American and French mineral, 
two, and sometimes three, wax impressions are re- 
quired, the plaster casts from which are used in the 
process of soldering, and of which we shall speak 
more particularly when we come to describe the 



MECHANICAL DENTISTRY. 



197 



various kinds of teeth that are employed as artificial 
substitutes. 

Casting the Model in Plaster of Paris. — 
Having the impression in wax, the next process will 
be to obtain a fac-simile of the deficiency in plaster 
of Paris. To accomplish this, mix the finest plaster 
of Paris or gypsum in a sufficient quantity of water, 
in a common basin, with an iron spoon, until it ac- 
quires the consistence of cream ; then gently pour a 
little of it on one end of the wax impression, hold- 
ing it somewhat obliquely, so as to allow the liquid 
plaster to run into each hollow made by the natural 
teeth in the wax, at the same time gently tapping 
the under surface of the frame ; the object of which 
is to prevent air-bubbles in the plaster cast, which 
would occur should these precautions be neglected, 
particularly if too great a quantity of plaster were 
placed in the mould at the commencement. When 
the impression has been filled to a level with its 
edges, continue to add more plaster until a sufficient 
size and thickness is attained, to withstand any 
pressure that may be necessary in taking a metallic 
cast. 

In ten minutes, if the finest plaster of Paris has 
been used, it will be sufficiently set to allow of the 
separation of the wax from the plaster. This is done 



198 



MECHANICAL DENTISTRY. 



by immersing the lower part of the model containing 
the wax impression in hot water, and allowing it to 
remain until the wax is again softened : by gently 
raising the edges of the wax it will then be found to 
separate from the plaster with ease and safety. 

The plaster cast must now be trimmed, by means 
of a knife, to a proper shape and form, that it may 
be readily withdrawn from the model sand when tak- 
ing the metallic cast. The form it should now assume 
is the following. 




After trimming the cast to the above shape, and 
cutting off level with the plaster the ends of the iron 
wire that project beyond the edges of the teeth, it 
should be thoroughly dried either in an oven or be- 



MECHANICAL DENTISTRY. 



199 



fore a fire, and while warm, immersed for two or 
three minutes in a composition, previously melted, 
of equal parts of white wax and resin ; this will give 
it a surface, and materially guard against a wearing 
of the model in trying on the plate ; it will also faci- 
litate its removal from the casting sand. 

Casting Metallic Models. — From the plaster 
model it is necessary to obtain a fac-simile in some 
kind of hard metal that will fuse at a low tempera- 
ture, and upon which ultimately a gold plate can 
be formed. For this purpose a compound metal is 
prepared, which is kept at most of the dental reper- 
tories, under the name of spelter ; it consists of zinc, 
bismuth and tin ; but some mechanical dentists use 
zinc or tin alone. 

The method of taking a metallic cast for dental 
work is very similar to the one employed by brass 
and iron founders, and is generally adopted now by 
dentists, as being both economical and expeditious. 
It consists in filling an iron ring, 4| inches in depth, 
and 6 inches wide, with modelling sand, which has 
been previously moistened with water to a consist- 
ence that will allow it to cohere readily when pressed. 
The plaster cast is now pressed gently and firmly 
into the sand, and cautiously withdrawn in a perpen- 
dicular direction. This must be repeated until a 
clear and distinct impression is observed. Practice 



200 



MECHANICAL DENTISTRY. 



alone will soon teach the operator how to shape his 
plaster cast so as to facilitate its withdrawal. In 
each impression of the teeth insert a thick iron wire, 
about an inch in length, to prevent the teeth from 
breaking off or receiving injury during the process 
of striking up the plate. 

The mould now in the sand must be filled with 
the spelter or zinc, which has been previously melted 
in a common ladle. When the spelter cast is cold, 
any slight inequalities in it around the inner necks 
of the teeth may be removed by a file or sculper, and 
made to represent the plaster cast. 

The operator being now provided with what is 
termed his working cast in spelter, it is necessary 
that he should have a similar one in lead, which is 
obtained in precisely the same manner as the ]ast. 
This being made, melt in a ladle capable of holding 
a pint and a half of fluid, as much lead as will fill it ; 
into this molten lead immerse the lead cast (pre- 
viously smeared with fluid plaster of Paris) half way 
up from the edges of the teeth to the broad part of 
the cast; immediately place the ladle on a vessel 
filled with either wet sand or water, up to about two 
inches from the edge, as follows. This will prevent 
the re-fusion of the leaden cast. Care should be 
taken not to insert the lead cast into the body of 
melted lead when too hot, which would produce a 



MECHANICAL DENTISTRY. 



201 




fusion of the former, and render a repetition of the 
operation unavoidable. When cold, the cast is to be 
separated by striking the outer edges of the body of 
lead with a heavy hammer. 

When the gold to be employed is large and thick, 
it becomes necessary to have two metallic castings in 
spelter, as the sharpness of the first is generally 
destroyed in the working ; but in ordinary cases the 
operator will find he is provided with a sufficient 
number of metallic castings, between which the gold 
plates can be fashioned. 

Whether a single tooth or a complete set be re- 
quired, the same process and mechanical manipula- 
tions are to be observed. 

To alloy Gold for Plates. — Gold plates, 
solder, wire, &c, are generally procured from the 
dental repositories, where they are kept of all sizes 
and qualities ; but as some students may be desirous 
of knowing how themselves to prepare them in cases 
of emergency, we shall here, for their guidance, de- 

k a 



202 



MECHANICAL DENTISTRY. 



scribe the process. As a rolling mill and other ex- 
pensive implements are necessary for the purpose, it is 
best to purchase the above materials ready prepared. 

The gold plate employed for artificial work, never 
ought to be less than 18 carats, nor higher than 20, 
and the alloy should be silver ; for if copper be used, 
the patient, when the work is inserted in the mouth, 
is seldom, if ever, free from a metallic taste, the 
result of the chemical action of the salts of the saliva 
upon the alloy. The 18 or 20 carat gold, which is 
mostly used by respectable dentists, is prepared as 
follows : — Take twenty parts of fine gold, and alloy it 
with four parts of pure silver ; melt the two metals 
with a lump of borax in a crucible, well secured at 
the bottom with fire clay, in a charcoal fire ; when 
in a state of fusion, run the mass into an ingot of 
convenient size and shape; after which hammer it, 
and pass it through a rolling mill, until it be reduced 
to the required, thickness. The plate should then be 
annealed by heating it to redness, and afterwards 
cleaned by boiling it for a few minutes, in either 
muriatic or sulphuric acid, diluted in the proportion 
of one ounce of acid to fifteen of water. 

Wire Making. — When the plate has been re- 
duced to the thickness of half-a-crown by the rolling 
mill, cut it into narrow slips ; file the point and draw 



MECHANICAL DENTISTRY. 203 

it through the largest hole in a draw-plate fixed in a 
large vice ; pass it through the next hole, and so on 
until it be reduced to the required size. 

Making Solder. — The solder employed for plates 
of 18 carats, may be prepared in the following 
manner : — To 2 pennyweights 22 grains of fine gold 
add 16 grains of pure silver, and 12 of roset copper ; 
melt in a crucible with borax. It is necessary, for 
convenience in working, that the solder should be 
rolled into very thin plates, and well cleaned pre- 
vious to its being used for work. 

Essentials. — During the process of making the 
plate, it is necessary that the operator should be pro- 
vided with a piece of charcoal or pumice-stone, for 
the purpose of annealing, and soldering on springs, 
rivets, &c, as also to sustain the work, and confine 
the heat while under the blast of the blow-pipe. For 



204 



MECHANICAL DENTISTRY. 



small pieces of work, pumice-stone is preferable ; but 
for sets and large pieces, a round block of charcoal 
will be requisite, 5 inches in diameter and 8 in length, 
hollowed in the form of a mortar, the outer surface 
being either covered with plaster of Paris, or en- 
cased in a moderately thick iron plate, as above 
represented. 

Soldering Lamp. — A soldering lamp, similar to 
the annexed representation, may be procured. It 



should be capable of holding a pint and a half of oil ; 
the length of the spout, into which the cotton wick 
is inserted, being from three to four inches, while 
the orifice is about three quarters of an inch in 
calibre. The common gas however is far preferable 
to the lamp, as all the smell, dirt and trouble attend- 
ing the latter are thereby avoided. 

Blow-pipe. — This instrument should vary from 
15 to 17 inches in length, and should have an orifice 
that will admit a small knitting-needle. The eyes 




MECHANICAL DENTISTRY. 



205 



are liable to be seriously injured by the use of the 
short blow-pipe, and therefore the long one should 
be preferred : and those who feel incommoded by the 
light in the use of either, should wear a pair of 
common green spectacles. 




A Blow-pipe with Bellows attached. — In some 
constitutions the habit of using the blow-pipe is ex- 
ceedingly injurious to the lungs. Where this is 
the case, the operator may substitute the following 
method. In the centre of a frame made of stout 
wood or iron, support a pair of moderate-size furnace- 
bellows by means of a swivel screwed to each side of 
the frame. To the nozle firmly secure an elastic 
tube of sufficient length, at the end of which fasten 
the common blow-pipe. Upon the top of the bellows 
place a weight corresponding to the strength of the 
frame-work and the size of the bellows. To the back 
part of the latter attach a treadle of convenient 
length and breadth, by means of which the appa- 
ratus may be worked like a lathe, and the blow-pipe 
applied with the greatest facility either to the flame 
of gas or of the common oil lamp. The student 
should however be extremely cautious in this use of 



206 



MECHANICAL DENTISTRY. 



the blow-pipe while soldering, and should closely 
watch the colour of his metal ; otherwise by the 
intense heat a large piece of work may in a few 
minutes be melted away. 

Annealing. — For this purpose a constant blast 
from the blow- pipe should be given to the metal placed 
on the charcoal, until it has assumed a red heat. 

Soldering. — This process is accomplished by 
steadily directing on that part of the work intended 
to be soldered, a constant blast from the blow-pipe, 
and gradually bringing the flame to a focus until the 
solder fuses. If the student use the common in pre- 
ference to the bellows blow-pipe, he must learn the 
habit of breathing through the nostrils, so as con- 
stantly to expel a current of air through the blow- 
pipe by the action of the muscles of the cheek. 

Simple as this may appear to the casual observer, 
it will be found upon trial, that to become an adept 
in soldering, and to use the blow-pipe without dis- 
tressing the lungs, requires considerable patience 
and perseverance ; and we would strongly recom- 
mend the student, instead of trying his skill upon 
gold, to experimentalize upon some other metal, 
such as silver or pinchbeck, before he attempts a 
piece intended for the mouth of a patient. 

The surface of the gold plate to which a spring, 



MECHANICAL DENTISTRY. 



207 



rivet, or tooth is about to be attached by means of 
the solder, should be perfectly clean, and should be 
slightly touched with an aqueous solution of borax, 
laid on with a camels-hair brush, on the edges of 
those parts where it is desired that the solder should 
take effect. The surface best adapted for rubbing 
the borax upon, is a common piece of slate, cut to a 
convenient shape, and embedded in plaster of Paris 
like the charcoal before figured and alluded to. 

The solder, having previously been cut in small 
bits, is placed in contact with the two pieces to be 
soldered, which are kept in the proper position either 
by twisting a piece of binding wire around them, or 
by means of an iron cramp similar to this, which is 




made by flattening the two ends of a piece of wire, 
and by means of pliers turning it into the above 
shape. 

Another method is frequently adopted, viz., that 
of soldering upon the extra plaster cast, and which 
we shall more particularly allude to when we treat of 
soldering teeth to a plate. 

When the spring or rivet has been properly ad- 
justed, the flame is to be brought very gradually 



208 



MECHANICAL DENTISTRY. 



upon the parts intended to be united, until they are 
nearly white hot ; but the very instant the solder is 
fused and runs over those parts, the jet of flame 
must be withdrawn, otherwise the larger portion of 
the metal will be liable to be melted. 

The great art of soldering consists in knowing just 
the volume of flame proper to be used in a given 
case, and the exact point (indicated by the colour of 
the metal) when the flame should be withdrawn : but 
practice alone can give this knowledge. 

Cleaning Gold Plates. — The surface of a gold 
plate, after being submitted to the flame of a blow- 
pipe, becomes black from oxydation. This is re- 
moved by boiling the plate in diluted muriatic acid, 
in a copper vessel : to accelerate the process, the 
copper vessel may be held over the flame of the sol- 
dering lamp or gas-light. Nitric and muriatic acids 
should never be employed conjointly in cleaning, 
for the compound of these two acids forms that 
solvent of gold termed aqua regia. Where the ope- 
rator has occasion to employ silver, he should use 
the dilute sulphuric acid for cleaning his work. 

We shall now presume the operator to be in full 
possession of the above details, and to be competent 
to follow us when in future we allude to the con- 
struction of plates, soldering, &c. 



MECHANICAL DENTISTRY. 



209 



Making the Plates. — Being now provided with 
metallic casts, proceed to cut a piece of sheet lead to 
the spelter model, of the exact shape and size that 
the gold plate is intended to be : this lay on the 
sheet gold, and with a point trace its pattern. Then 
with either of the subjoined instruments cut the 
plate to the outline indicated by the point. Anneal 




the gold, and place it on the metallic cast. By 
means of pliers and a hammer made of cow-horn, 
adjust the plate as nearly as possible to its intended 
position. After this is accomplished, place the cast 
with the gold plate in the lead die, and with a 



210 



MECHANICAL DENTISTRY. 



wooden mallet, and heavy blows on the cast, strike 
up the plate. This must be repeated several times, 
until the gold is forced into the various inequalities 
of the metallic cast. File away a sufficient quantity 
from that part of the plate which comes in contact 
with the natural teeth remaining in the mouth, so as 
to allow for the additional thickness of the spring j 
and then adjust around the tooth on the metallic 
cast, a strip of 16-carat plate cut to the requisite 
width. Having cleaned the edges both of the plate 
and spring, and primed, as it is technically termed, 
with borax and solder, the spring must be tempo- 
rarily held in the intended position, either by twist- 
ing a piece of fine binding wire to some one point on 
the plate that will hold it firmly, or else by the 
cramp figured above (p. 207). It must now be 
brought under the action of the blow-pipe, as before 
described, and when cold, again replaced on the 
metallic cast, and again struck up between the die 
and cast. The front edge of the plate should now 
be filed nearly to the edge of the gum, and to within 
four or five lines of the front surface of the remain- 
ing natural teeth in the mouth : and the intervening 
spaces that are to be occupied by the artificial teeth 
on the plate should also be filed away. The plate 
will then present the following appearanee. A, repre- 



MECHANICAL DENTISTRY. 



211 



sents the anterior part of the plate ; B, the posterior 
part, extending to the roof of the mouth. C and 




D are the front springs, which will require to be 
reduced if too conspicuous when inserted in the 
mouth. E and F are the back part of the springs, 
which in this case only extend to the first bicuspids 
on either side. By means of E and F the plate is 
firmly secured in its position, otherwise it would be 
liable to be constantly displaced by the action of the 
tongue and the food, or to be tilted by the approxi- 
mation of the opposing teeth. 

The proper teeth, whether the natural or the 
English mineral, are now to be selected; if the 
latter, the operator should be particular in choosing 
specimens all of the same colour, shape, breadth and 
thickness. If the teeth be too long, they can either 
be chipped by a three-cornered file, ground smooth, 
or ground down by means of emery wheels fixed 
upon a lathe, and of which there are many shapes. 

These stone wheels are attached to lathes of va- 



212 



MECHANICAL DENTISTRY. 




rious sizes for the workshop : the most simple and 
economical lathe is represented in the following 
figure ; and when enclosed in a case of polished ma- 




MECHANICAL DENTISTRY. 



213 



hogany, it becomes a respectable piece of furniture 
for the operating room. 

Choice of Teeth. — It is here necessary to ob- 
serve, that when we speak of the teeth to be mounted 
on the plate, we refer for the present only to the 
natural, or else to the English mineral teeth ; for in 
the former of these, the natural canal remains ; and 
in the latter, the hole for the pivot necessary to fix 
them to the plate, is manufactured with the teeth, 
and corresponds in position with the natural orifice. 

Fitting the Teeth to the Plate. — The plate 
being placed upon the cast, and the teeth selected, 
the next process is to rough-fit them to the plate. 
This is done by repeatedly applying the base of the 
tooth to that part of the plate to which it is to be 
fixed ; the plate having previously been painted with 
vermillion and oil; and by cutting away, with the 
emery wheel, that portion of the tooth that is marked 
by the color. 

The exact point where the rivet is to be inserted, 
so as to correspond in position to the natural teeth 
in the mouth, must now be ascertained. This is 
done by temporarily fixing the teeth in their intended 
places on the plate by means of a piece of warm 
bees-wax ; on the removal of which, a raised point 
will be observed, corresponding to the openings in 



214 



MECHANICAL DENTISTRY. 



the teeth ; and at this point the rivet is to be inserted 
by first drilling a hole of the same size as the gold 
wire intended to be used for the rivet, and soldering 
it to the plate in the usual manner. The plate and 
rivets will now assume the following appearance. 




The process of fitting the teeth must now be con- 
tinued until they are reduced so as to correspond 
in length with those in the mouth. In most cases it 
will be found necessary to file away the outer edge of 
the plate somewhat, in order to allow the teeth to 
project, so that when inserted in the mouth, their 
edges shall come in close contact with the gum. 

Fastening the Teeth to the Plate. — The teeth 
(if natural) are to be fastened on the pivots by means 
of a little flos silk wound round the latter, which 
must be previously indented or jagged with a file. 
Moisten the silk with mastic varnish, and press the 
teeth firmly on. When mineral teeth are used, and 
the length of the pivot will allow, the above method 
of fixing may still be employed ; but in short cases, 



MECHANICAL DENTISTRY. 



215 



the common flowers of sulphur may be used for these 
teeth, with the utmost success ; as follows : — Place 
the teeth on their rivets, and insert a small quantity 
of sulphur between the rivets and the tubing ; hold 
the plate over a spirit lamp until the sulphur melts ; 
then allow it to cool gradually, and it will be found 
that the teeth are securely fixed to the rivets. Some 
dentists use pewter solder in the same manner ; it is 
objectionable, inasmuch as it yields a constant me- 
tallic taste in the mouth. 

Finishing and Polishing the Plate. — When 
the teeth have all been fixed, the edges of the plate 
must be rendered perfectly smooth and even by a 
fine gold file and burnisher ; and the whole must be 
highly polished with a soft brush similar to the next 
figure, and attached to a lathe. Finely levigated 




pumice, emery, crocus, or whitening and water may 
be employed for this purpose. 

A plate or piece of the kind we have been de- 



216 MECHANICAL DENTISTRY. 

scribing, containing English mineral teeth, would 
present the following appearance when finished. 




The foregoing observations apply, as we said before, 
only to the employment of natural and English mi- 
neral artificial teeth : we now proceed to describe 
other varieties of teeth, and the method of fixing 
them to the plate. 

Stockton's American Mineral. — Teeth of this 
description are manufactured on a large scale in 
America by the gentleman whose name they bear : 
they beautifully resemble the natural teeth both in 
shape and colour, and when it is necessary to supply 
an artificial gum, they are manufactured .with a fac- 
simile of this substance attached : a device which has 
not at present been brought to perfection anywhere 
but in the United States. The use, however, of these 
teeth is chiefly confined to that country ; owing pro- 
bably to a bad imitation having some two years since 
been manufactured in England, where it was hawked 
about by a pretended agent from the manufacturer. 



MECHANICAL DENTISTRY. 



217 



Stockton's mineral teeth are a great improvement 
on the old French mineral, and are not surpassed 
in appearance by the English mineral. Their un- 
equalled strength and durability render them invalu- 
able in those cases where the approximation of the 
jaws is so close, particularly in the front part of the 
mouth, that it becomes necessary to reduce the back 
part of the tooth to such an extent, that the slightest 
pressure from the opposing teeth would be sufficient 
to break it off the plate if the English mineral were 
used. These teeth can now be adapted with equal 
facility in all cases in which artificial teeth are used ; 
for the maker has recently introduced the molars 
and bicuspids for the back part of the mouth, of the 
same shape as those manufactured in England. 

Those used for the front of the mouth are what 
are termed, in mechanical phraseology, shell teeth. 
At the back of these are small platina pivots, which 
are inserted during manufacture, and by which the 
teeth are attached to the plate. 




The plate having been made and adjusted to the 
plaster in the usual manner, select teeth of the above 

L 



218 



MECHANICAL DENTISTRY. 



description, of the proper shape, colour and size ; by 
means of the emery wheels, oil and rouge, rough-fit 
them to the plate ; cut a piece of gold plate nearly 
as large as the back surface of the tooth, and by 
means of a punch of this description, pierce holes 




in the plate and insert the pivots : as thus. 




After priming the plate, solder it to the tooth in 
the usual way, taking care not to raise the heat too 
suddenly, lest the enamel of the teeth should crack. 
Be cautious also not to cool the tooth too suddenly, 
after it has been soldered to the plate. The sur- 
face over which the solder has taken effect, may be 
smoothed with a gold file and polishing brush. 

Place the plate on a second plaster cast which has 



MECHANICAL DENTISTRY. 



219 



been taken for the purpose of soldering upon. By 
the aid of a file and the emery wheels, fine-fit the 
teeth to the plate, taking care that the gold plate at 
the back of the tooth fits closely to the plate on the 
model ; and observe particularly that the front edges 
of the teeth come well over the edge of the plate, 
in the same manner as the natural and English mi- 
neral before referred to. Now arrange the teeth on 
the plate in the exact position they are to occupy in 
the mouth, as regards the adjacent teeth on the 
model, and those in the opposing jaw. Support the 
teeth temporarily in their places by a piece of bees' - 
wax laid behind the back of the teeth, and coming 
in contact with the plate ; the wax being made to 
adhere by gently warming the work over a spirit 
lamp. Replace the piece on the cast, and cover the 
enamel surfaces of the teeth with plaster of Paris. 
When this sets, remove the wax from behind with a 
point. The piece is now ready for soldering, which 
must be done neatly but strongly. After applying 
the borax to the edges of the two plates, put a suffi- 
cient quantity of solder on the part, and round it, 
in a semi- circular form, apply a thin coating of 
plaster or whitening, to prevent the solder from dif- 
fusing itself over any other part of the work. 

With respect to artificial work in which the teeth 

l 2 



220 



MECHANICAL DENTISTRY. 



are backed with gold, or where much solder has been 
employed, it is necessary, previous to its being 
finished and inserted in the mouth, that it should be 
submitted to a chemical mixture, to decompose the 
copper in the solder. For this purpose boil the work 
for half an hour in a porcelain vessel containing the 
following ; a quantity of which should be always 
kept ready : 

Muriate of Soda, \ ounce, 
Nitrate of Potass, 8 ounces, 
Alum, 2 ounces, 

Water, 24 ounces; 

Mix. 

Next boil in a solution of bicarbonate of soda or 
potass, and lastly in water. 

If the work has been properly executed, a single 
tooth of the kind we are describing, when viewed 
laterally in connexion with a section of the plate, 
will agree with the following representation. 



MECHANICAL DENTISTRY. 



221 



Again, a piece for the front of the mouth, when 
the same teeth are used, and properly finished, if 
viewed from behind, will resemble the annexed. 




Taking the Bite. — In large pieces of artificial 
work, previous to finishing and before the teeth are 
soldered to the plate, it is essential to try the plate 
in the patient's mouth for the purpose of taking the 
bite. This is done by covering that part of the plate 
upon which the teeth are to be fixed with bees' -wax 
made to adhere by heat. The plate is then inserted 
into the mouth, and the patient closes the jaws in 
his usual manner : when the impression of the anta- 
gonizing teeth on the wax will indicate the exact 
position on the plate in which the artificial substi- 
tutes are to be placed and soldered, so that the teeth 
in the opposite jaw shall exercise no undue pressure 
when the mouth is closed and the piece finished. 
After this, the plate with the wax is replaced on the 
plaster cast, and the fac-simile model of the opposing 
teeth, (which was taken when the patient was first 
seen,) is placed in the impressions in the wax above 



222 



MECHANICAL DENTISTRY. 



mentioned. Next oil the back surface of the two 
models, and run plaster of Paris over them when 
set; separate the back from the plaster casts, and 
remove the wax from the plate. On placing the 
back to the models during the process of adjusting 
and fixing the teeth to the plate previous to solder- 
ing, it will be found that the operator has obtained 
an exact guide to direct him in fixing the teeth in 
their proper locations. If this part of the process 
be managed correctly, little or no alteration will be 
necessary when the piece is inserted in the mouth. 

The subjoined cut represents the two models with 
the back as above described. 



French Mineral Teeth.- — These teeth are fitted 
to the plate in the same manner as the American 
Mineral, and are soldered to a rivet previously in- 
serted in it in the way adopted in fixing the natural 




MECHANICAL DENTISTRY. 



223 



and English Mineral. The following gives the back 
view of a French Mineral Tooth. 



To obtain the exact point where the rivet should 
be soldered into the plate, place each tooth in its 
intended position, and support it behind with a piece 
of bees'-wax. Then carefully remove the tooth, and 
a raised impression on the wax will be observed cor- 
responding with the groove and platina at the back 
of the tooth. Now by means of a sharp point mark 
the corresponding depression on the plate, and there 
insert and solder the rivets in the usual way. 

Backing the Teeth. — The process of backing 
these teeth with gold is by cutting a piece of metal 
of the size of the back part of the tooth, and neatly 
adjusting it to the plate and back. This piece is sup- 
ported in its place by a piece of binding wire twisted 
round the tooth and plate as here represented. 





The two edges are soldered in the same manner 



224 



MECHANICAL DENTISTRY. 



as for fixing the American Mineral Teeth to the 
plate. A piece of French Mineral work when finished 
resembles the following. 




Pivoting Teeth. — When the greater part of the 
crown of a natural tooth has been destroyed either 
by caries or accident, an artificial one should be en- 
grafted upon the stump. If any portions of the 
tooth project beyond the gum, a pair of excising 
forceps are used for their removal. These should be 
so constructed as to give a sense of solidity and firm- 
ness when grasped in the hand of the operator ; and 
their cutting edges should be an eighth of an inch 
wide, as the following. 




The manner of applying these is to embrace the 
stump of the tooth as high up as the gum, and 



MECHANICAL DENTISTRY. 



225 



gently but firmly closing the handles, to bring the 
two cutting edges together. In using this instru- 
ment the operator should be exceedingly careful not 
to jar or shake the fang. 

It is also advisable in those cases where decay has 
not extended to the neck of the tooth, to divide it 
partially by means of a file or a fine watch-spring 
saw fixed in a frame, before the forceps are applied. 
Those portions of the crown of the 
tooth that projected beyond the gum £ 
having been removed, the surface of II 
the fang must now be filed to the re- |§|| 
quired form by means of an oval or fBi 
half-round file similar to the following, 
The file should be used with care 
and gentleness, and the root supported 
by placing the finger and thumb be- 
hind, which will leave the sides of the 
root higher than the centre, and pre- 
vent the artificial crown that is about lili 
|7 to be fixed from turning round upon its 

axis, and will also materially assist in v J 
retaining it in its position in front; fn 
otherwise the friction and continual n 
jarring of the file may occasion inflam- II 
matory action of the investing mem- 1| 
brane and surrounding parts, and en- * 



tip 
ii 



226 



MECHANICAL DENTISTRY. 



tirely preclude the success of the operation. The 
fang having been reduced to a level with the edge of 



the gum, the nerve, if still alive, should 
now be immediately destroyed by intro- 
ducing the point of a square drill fixed in 
a handle of this description ; force the drill 
firmly and steadly up the fang, and in- 
stantly give it a rotatory motion; with- 
draw the instrument, and permit the pa- 
tient to wash his mouth with warm water, 
to which has been added a few drops of 
laudanum ; after which proceed gradually 
to enlarge the natural orifice to the required 
size and depth by means of drills similar 
to the annexed. The operator should be 
provided with a number of these varying 
in size from that of a common pin to a 
middling-sized knitting needle. The drills 
should be exceedingly soft, otherwise by 
any sudden movement of the patient's 
head during their application, they are 
liable to be broken in the fang. The depth 




to which the drill is carried must depend entirely 
upon the length of the fang, but should never be 
less than a quarter of an inch. 

The above method of destroying the nerve and 
enlarging the natural orifice in the tooth, generally 



MECHANICAL DENTISTRY. 



227 



occupies a considerable time ; but as it is invariably 
attended with pain, it is a great point to perform it 
as expeditiously as possible. 

For this purpose Mr. Mc Do wall, of LincolnV 
Inn-Fields, has invented a very ingenious and simple 
instrument upon the principle of the helix-lever. At 
the end of the screw is inserted a drill which is made 
to revolve with the greatest rapidity by means of a 
female screw attached and fixed in a handle. The 
mechanical parts of the instrument are enclosed in a 
tube, and so arranged that it can be made equally 
available for excavating caries at almost any angle 
that may be required, by merely unscrewing the 
upper end of the tube and substituting the addi- 
tional heads, in which the action is reversed. 

The following engraving represents the different 
parts of this instrument. 




The root of the tooth having been thus prepared, 
the operator must now select an artificial crown of 
the same colour, shape and size as the natural teeth 



228 



MECHANICAL DENTISTRY. 



remaining in the mouth, and as nearly of the same 
length as possible ; then fit the artificial substitute, 
by means of rouge and oil, carefully and accurately 
to the natural stump ; observing that it is in an exact 
line with the anterior surfaces of the other teeth, 
and fits closely to the posterior part of the root. 
When this has been done, temporarily, 
fix the new crown in its intended posi- 
tion by means of a piece of dog-wood or 
birch. 

The patient must now bring together 
the opposing teeth, and provided the arti- 
ficial crown does not strike its antagonist, 
or in any way press against the adjoining 
teeth, it may be permanently fixed. It is 
however necessary in those cases when a 
washer is employed, as in the English 
mineral, to apply an instrument to the 
centre of the root, for the purpose of re- 
moving that portion of the bone that would 
otherwise come in contact with the washer, 
and prevent a proper adaptation of the ar- 
tificial crown to the root and gum. 

In such cases, the following rose-top 
drill fixed in a handle may be used, By 
applying it to the orifice and giving it a 



MECHANICAL DENTISTRY. 



229 



slight rotatory motion, it will be found on applying 
the artificial crown that the joint is quite perfect.* 

Pivoting Natural Teeth. — If the crown to be 
pivoted be natural, it will be necessary to ascertain 
the position of the hole in the root, so as to make 
the opening in the crown correspond exactly with it. 
This is done by covering the body of the artificial 
substitute with a thin layer of bees'-wax, and apply- 
ing it to the surface of the root. On removing the 
former, a raised point will be observed corresponding 
with that in the fang : a hole must now be drilled at 
that point, and a screw formed by gently turning a 
piece of gold wire of the proper size in several holes 




of the above screw-plate. After which the screw 
will be of the following shape. 

* Two very ingenious instruments have recently been invented for 
this purpose by Dr. E. Townsend, of Philadelphia. They consist of 
an oval and a hollow file ; the former fitting exactly into the latter. 
Dr. T. makes use of the oval instrument for filing the root ; of the 
hollow one, for filing the artificial crown. 



230 



MECHANICAL DENTISTRY. 



The screw end must now be inserted into the arti- 
ficial crown, and the other into the natural stump. 
If the power of the hand be found insufficient to 
force it into its place, the object may be effected by 
the aid of a wooden instrument constructed like the 
following. 




Pivoting English Mineral Teeth. — Should one 
of these teeth be used, it will be necessary to have 
soldered to the gold pin, close to the basis of the 
crown, a washer, so that when inserted into the 
stump, it resists the pressure necessary to force the 
pivot into its position ; otherwise pivoted teeth of this 
kind are liable to slide down the pivot, and render 
the operation difficult and uncertain. 

The tooth in short cases is fastened to the pivot by 
sulphur, or in long cases by flos silk in the usual 
way. A pivoted tooth of this kind, when ready for 
insertion, resembles the following. 



MECHANICAL DENTISTRY. 



231 



Pivoting American Mineral Teeth. — These 
teeth are adjusted to the stump in the same manner as 
the last, but the method of fixing them permanently 
is materially different, inasmuch as a pivot of hickory 
is substituted for the gold, the holes of these arti- 
ficial crowns not going through the teeth. A piece 
of this wood is rounded and smoothed to the size of 
the hole by means of a file and sand-paper, and 
firmly pushed into the artificial crown ; the remain- 
ing part of the pivot that projects from the crown is 
cut to the length required, and reduced by the file 
to the size of the orifice in the fang. To insert the 
pivot into the natural root, the pressure need not be 
great, since the temperature . of the body, and the 
swelling of the wood, when the latter is saturated 
with the moisture of the mouth, will be sufficient to 
secure the pivot firmly in its position. The following 
present a front and lateral view of an American 
pivoted mineral crown prepared for insertion. 





Pivoted Teeth on a Gold Plate. — Occasion- 
ally the natural fang in the mouth is situated behind 



232 MECHANICAL DENTISTRY. 



the circle of the other teeth, in which position it 
will not admit of either of the before-mentioned 
methods being adopted ; and when a tooth of either 
of the above kinds is inserted, it will be found either 
to be too far back or too far forward, or to have too 
great a lateral inclination to the right or the left 
side. In these cases an entirely different course of 
procedure must be pursued ; as follows. After pre- 
paring the root as before mentioned, insert a small 
piece of dog-wood cut to the size of the natural hole 
in the fang. An impression in wax of the deficiency 
must now be taken in the usual way ; when by care- 
fully withdrawing the wax the wooden pivot will 
adhere to the wax. Run plaster of Paris into the 
impression containing the pivot ; when set, separate 
the plaster from the wax; dry the model, and im- 
merse it in bees'-wax and resin for a few minutes ; 
then remove the pivot from the cast, when it will be 
seen that the position it occupied corresponds with 
the hole in the natural root. A gold plate must now 
be made in the usual way ; and when properly ad- 
justed to the plaster cast, lay a small piece of bees' - 
wax upon the under surface of the plate, which 
comes in contact with the root in the jaw ; then 
replace it upon the model, and on removal, a raised 
point will be seen on the wax, in which place the 



MECHANICAL DENTISTRY. 



233 



pivot is to be inserted and soldered. The artificial 
crown may now be fixed to the plate at any required 
point, so as to correspond with the teeth remaining 
in the mouth. The following represents a pivoted 
tooth on plate of this description. 




American and French Mineral Teeth pivoted 
on Plate. — The same mechanical manipulations and 
nicety must be observed in fixing these teeth to the 
plate for pivoting, as we have already detailed for the 
guidance of the student in the foregoing observations. 
These teeth, when thus constructed, on a lateral 
view, and from behind, present the following ap- 
pearance. 




Observations. — A pivot may occasionally require 
to be placed on one side of the centre of the fang, in 
which case it may be thus represented. 



234 



MECHANICAL DENTISTRY. 




When the size of the orifice in the root is large, a 
piece of hickory may be inserted first, and the me- 
tallic pivot inserted into the wood. 

Metallic pivots, when placed in contact with the 
bone of the fang, occasionally loosen by abrasion. 
To prevent this result, the pivot should be either 
roughed with a file, and covered with flos silk, slightly 
moistened with a solution of mastic ; or be encased 
with a thin layer of well-seasoned hickory. 

In conducting the operation for the insertion of a 
pivoted tooth, the student should bear in mind the 
necessity of so placing it in the mouth, that the 
opposing tooth does not come in contact with it : 
otherwise the continual pressure is not only liable to 
produce inflammation in the socket of the fang, but 
renders the artificial crown liable to fracture, which 
may subject the patient to great inconvenience. 

Artificial Teeth set inBone, orSucTioNPiECEs. 
— Another method of supplying artificial teeth, is 
that of inserting either mineral or natural teeth in 
sockets of dentine, or occasionally, for economy's 



MECHANICAL DENTISTRY. 



235 



sake, in sockets of elephant and walrus tusks. Both 
the latter, however, are far inferior in durability and 
colour to dentine, and always occasion unpleasant 
effluvia from the mouth. The hippopotamus or den- 
tine is far preferable to them, as possessing a much 
closer texture of fibre, a whiter colour, and greater 
durability : another important advantage it possesses 
is, that the greater part of its surface is covered with 
enamel, and when desired, this natural covering can 
be made available for forming artificial teeth for the 
front part of the mouth. It is however better 
adapted for the sides ; because, after being worn for 
a short period, the enamel assumes a bluish-white 
appearance. 




Cutting the Tusk of the Hippopotamus into 
Blocks. — If the operator wishes to insert mineral or 
natural teeth in his artificial socket, or only intends 
carving a representation of them in the plain bone, 
it is necessary that the fibres of the tusk be applied 
horizontally to the plaster model. For either of the 



236 



MECHANICAL DENTISTRY. 



above purposes, a piece should be cut transversely 
(as shewn by the dotted lines in the above diagram), 
and the block formed out of it by again dividing it 
down the centre lengthwise. 

If we intend that the artificial teeth shall have the 
enamel on their anterior surfaces, the tusk must be 
divided in a transverse direction : previous to which, 
however, the student should ascertain by means of 



his compass that a sufficient 
thickness of bone is left for 
the depth of socket. In this 
instance, when the bone is ap- 
plied to the model, it will be 
found that the fibres run per- 
pendicularly. 

Fitting the Block to the 
Models. — The surface of the 
model, having been previously 
prepared with wax and resin, 
is now painted over with rose- 
pink and oil, and the block 
being applied horizontally, a 
portion of the colouring matter 
adheres to the bone, at the 
points of apposition, and thus 
indicates the parts to be re- 
moved by sculpers ; with a va- 




MECHANICAL DENTISTRY. 



237 



riety of which., of different sizes, the operator should 
be provided. The process of removal or excavation 
must be continued after each application of the bone 
to the model, until a sufficient depth of socket is 
formed, and the bone comes in close contact with 
every point and inequality on the surface. A similar 
adaptation must also be made on a second model 
reserved for the purpose, the first having lost its 
sharpness from the repeated applications of the 
bone. 

The piece must now be reduced by files and rasps 
to nearly the size and shape it is ultimately intended 
to assume, which will be nearly as follows.* 




* An ingenious machine to supersede manual labour in the above 
process, has been invented by Mr. Tomes ; but from the imperfect 



238 



MECHANICAL DENTISTRY. 



Fitting the Piece in the Mouth. — At this 
stage of the work it is necessary that the piece 
should be fitted to the mouth. For this purpose, 
first paint with rose-pink and oil the surface of the 
gum over which the piece is to extend, in precisely 
the same manner as was previously done with the 
plaster model; adapting the opposing teeth in the 
other jaw to the bite, by applying the colouring 
matter also to their cutting edges or grinding sur- 
faces, and removing those marks on the bone which 
result from the teeth, thus coloured, coming in con- 
tact with it. If the piece be intended for the upper 
jaw, the operator must reduce the external surface of 
the bone to the shape and size of the mouth, leaving 
the piece full at its lower edge compared to what it is 
at that part which comes in contact with the gum. 
He must also take care that perfect freedom of mo- 
tion is allowed to the frsenum of the lip ; and for 
this purpose must remove any portion of bone that 
may in the least incommode it. If the piece be for 
the lower jaw, it will be necessary to reduce the bone 
in the opposite direction, taking care to allow sufli- 

manner in which the most important part of the work is performed hy 
it, where under-cutting (a necessary operation in bone-fitting) is re- 
quired, it is not, in its present state, available generally in mechanical 
dentistry. 



MECHANICAL DENTISTRY. 



239 



cient space for the free movement of the tongue, and 
also bearing in mind the position occupied by the 
sublingual gland. 

Fitting in the Teeth. — Having accurately 
adapted the bone to the gum, lip, &c, a line must 
be made in the piece opposite the frsenum, so as to 
indicate the centre of the jaw, after which the pro- 
cess of fitting in may be commenced. This is done 
by grinding down the mineral teeth to a semi- ellip- 
tical form ; or occasionally cutting them in an oblique 
direction, so as to leave the posterior surface shorter 
than the anterior. This latter mode is more parti- 
cularly necessary when a thin socket is wanted. 
After having thus prepared the requisite number of 
teeth, which for a top set averages eight in front, 
(the posterior being formed out of the back part of 
the socket,) the two central incisors must first be 
fitted into the bone separately, colouring the fitting 
surface of the tooth with rose-pink and water, and 
applying it to the edge of the bone, so as to leave 
between the two teeth the line that indicates the 
centre of the jaw. The coloured points of contact 
are to be removed by means of a round file rather 
coarsely cut. Thus the tooth is to be carefully and 
accurately fitted into the bone to the required length, 



240 



MECHANICAL DENTISTRY. 



and temporarily fixed in its position with resin and 
wax; in each case being let down separately, and 
temporarily fixed in the above manner. 

In adjusting the two central teeth in partial sets 
on their artificial basis, it is common so to arrange 
them, that during the bite the interstice between the 
upper centrals shall exactly correspond with that 
between the lower. This practice will in a great 
measure account for the formal character and un- 
natural appearance that artificial teeth often present. 
It arises from the dentist not observing the actual 
position of the teeth during approximation of the 
jaws. For in most cases where there is a good den- 
ture, the above interstices do not coincide, but were 
they prolonged, would run nearly parallel to each 
other, at a distance of from three to six lines apart ; 
as here represented. Of course the student should 



MECHANICAL DENTISTRY. 



241 



be particular to arrange his teeth so as to present a 
similar appearance.* 

* This hitherto neglected fact is of singular interest not less to the 
practical dentist than to the philosophical physiologist. It forms one 
of a group of observations that tend to illustrate the mechanical laws 
of the human system. As an old writer has observed: — "The viscera, 
cavities and septa of the organic frame are not precisely equilibrated 
and sustained by each other in the manner of the well-poised scales of 
a balance ; that is to say, they are not symmetrical, nor of equal force 
and weight, on the right and left sides of the body. Thus the right 
lobe of the lungs is larger and more capacious than the left ; likewise 
the right cavity of the breast or pleura that encloses the right lung. 
The mediastinum behind the sternum is on this account inflected con- 
siderably towards the left. The right half of the plane of the dia- 
phragm surpasses the left half in size and strength ; so also the right 
half of the inferior muscle, with its crura and pedicles. Again, the 
heart does not lie exactly in the middle between the lungs, or upon 
the aponeurotic centre, but pulsates at the left side of the chest, in the 
opposite direction to the greatest force of the lungs. The stomach 
does not occupy the middle of the abdomen ; nor is its cavity con- 
structed on both sides with an equal arch: nor are its two orifices, the 
cardia and pylorus, found in the course of the same diameter. The 
spleen on the left side does not equal, although with the pancreas it 
sustains, the weight of the liver on the right side. The vena cava and 
the aorta, ... do not lie close to each other in their passage through 
the diaphragm. The one intercostal nerve does not run forth in the 
chest in the same manner as the other ; still less in the abdomen, and 
in the mesaraic plexuses. As it is in the whole body, so it is in every 
viscus of the body." The same remarks may be applied to the exte- 
riors of the frame, to the two sides of the head, the two eyes and eye- 

M 



242 



MECHANICAL DENTISTRY. 



Fixing the Teeth. — After filing and polishing 
the socket with sand-paper, finely-powdered pumice- 
stone, and whitening, the teeth should be perma- 
nently fixed in it ; first by ascertaining the exact 
point where the hole in the bone is to be drilled, 
corresponding with that in the mineral tooth ; this is 
done in precisely the same manner as described for 
the insertion of pivots in a gold plate. For fixing all 
English mineral teeth to bone sockets in the manner 

brows, also the arras, testes, legs, &c, &c. : in all which the structure 
as well as the energy of the function is manifestly unequal. Thus the 
perfection of the human body is not mere symmetry, but a profound 
harmony ; not the dead level of equality, but a living equilibrium 
between dissimilars ; an equilibrium constantly lost and restored : in a 
word, perpetual motion provided by means consummately mechanical. 
This is finely exemplified in the teeth. When the upper and lower 
teeth are brought one upon the other, so that the two central inter- 
stices precisely correspond, or form one line, we have the ghastly grin 
of the articulated skeleton : when on the other hand the interstices are 
parallel but not coincident, the freedom and play of the living mouth 
are adequately represented. It is curious, however, that in opening 
the mouth the central teeth and their median interstices come opposite 
to each other, clearly proving that in this act, as well as in closing 
the jaws, both of which acts appear to take place in a straight line, a 
rotatory motion is really performed. The energy of the molar action 
seems to be proportional to the above inequahty. The subject, how- 
ever, is new, though easily verified. Its practical consequences, we 
are inclined to suspect, may be very important. 



MECHANICAL DENTISTRY. 



243 



above mentioned, it will be necessary to solder to the 
rivet a thin washer of gold, to interpose between the 
tooth and the bone, so as to resist the blows of the 
hammer ; which might otherwise fracture the teeth. 
It is moreover essential that the rivet should be made 
of the softest gold wire, and the tooth fastened to it 
by means of sulphur or flos silk previously to being 
fixed. 

The part of the rivet to be inserted into the bone 
must be of sufficient length to project just beyond 
the inside of the socket ; the inner edge of the hole 
having been countersunk with a few turns of the 
rose-top drill used in pivoting. The cutting edge of 
the tooth is now laid on a piece of lead of convenient 
form, and the gold wire is rivetted on the inside. 

The head of the rivet must be reduced to a level 
with the inner surface of the bone by means of a 
sculper, and rendered smooth with sand-paper, &c. ; 
the posterior parts may be carved either to represent 
natural teeth, or they may be left plain externally 
and internally, and merely the crowns carved. 

Natural Teeth inserted in Bone. — The me- 
thod of fixing these teeth in bone is precisely similar 
to the above, except that after enlarging and extend- 
ing the natural opening in the crown of the tooth as 
far down as the enamel by means of a drill, a screw 

m 2 



244 



MECHANICAL DENTISTRY. 



is inserted instead of a plain rivet, and the teeth are 
not permanently fixed until the bone socket has been 
polished and stained to represent the human gum. 

Carving Teeth in Bone. — Previous to carving 
the teeth on the block, it is necessary to pencil an 
outline of their number, shape, breadth and length, 
on the surface of the bone, leaving a sufficient depth 
beyond the upper edge of each tooth to represent 
the gum. Then by means of engraving tools of 
various sizes and shapes the outline must be formed, 
and the character and shape of the teeth by degrees 
sculptured out. After this the piece must be polished 
with pumice-stone and chalk in the usual manner. 

Carving Teeth with Enamel Fronts. — Pre- 
vious to attempting to form these teeth, the enamel 
should be ground perfectly smooth, for from its ex- 
treme hardness, it is impossible to act upon it by the 
usual engraving instruments. This process must 
therefore be performed with appropriate files, after 
which the piece must be highly polished, as above. 

Mounting Gold Plates with Mineral or 
Natural Teeth on Bone Sockets. — Having fitted 
the bone to the model, the mineral or natural teeth 
are cut to their proper length and shape, and fitted 
into the bone in the manner before described. After 
the required number has been fitted and adjusted, 



MECHANICAL DENTISTRY. 



245 



remove the teeth, and secure the bone socket to the 
model by running plaster of Paris round its edges, 
A correct metallic cast and lead die must now be 
made in the usual way, between which the shape of 
the gold plate is formed ; when this has been done, 
accurately fit the plate to the bone by means of rose- 
pink and oil, and with the sculpers, as before men- 
tioned. If the plate be small, and required to cany 
only one, two, or three teeth, this process will be 
sufficient. In large pieces of work, where it is neces- 
sary to insert eight or ten teeth, the operator must cut 
out the bone to the required shape and depth that his 
gold is to have, previous to his taking the metallic 
castings. It will then be found, if he has modelled 
correctly, that the plate will fit the bone without 
much trouble. 

The plate then having been accurately fitted to 
the bone socket, the usual rivets to which the teeth 
are fixed are soldered to the plate. In large pieces 
of work it is necessary to drill three or four holes 
through the bone socket, leaving the gold wire form- 
ing the rivets, and corresponding with the hole in 
the bone, of sufficient length to allow of its being 
rivetted on the inside of the bone socket ; by this 
means the front part of the plate will be securely 
fastened to the bone ; the back part can be secured 



246 



MECHANICAL DENTISTRY. 



by using three or four cone-shaped rivets similar 
to the following, and rivetting them in the same 
manner. 

I 

The operator should fasten his teeth on the plate 
(if sulphur be used) in the usual way before he com- 
mences the rivetting ; otherwise the bone is likely to 
be injured by the heat employed. 

The following engraving represents an entire set 
of this description ready for insertion ; also the plate 
attached to the bone on the inside of the upper row, 
with a front view of the lower row. 

Colouring the Bone. — Eor this purpose a liquid 
is used composed of one scruple of cochineal, one 
drachm of muriatic acid, three grains of alum, and 
two drachms of water : which ingredients are rubbed 
together in a glass mortar, and the parts intended to 
represent the gum are carefully painted over with the 
compound applied on a cameFs-hair brush. After a 
few minutes the piece is immersed in cold spring 
water ; and on brushing its outer surface, it is found 
to represent the natural gum. Colouring the bone 
in this manner is merely a matter of ornament, 



MECHANICAL DENTISTRY. 



247 




which may well be dispensed with, as it lasts but 
for a few days, and merely serves the purpose of 
giving an appearance of finish to the work. 

Preparing the Sides of the Pieces for Spiral 
Springs. — If it should be necessary to attach these 
springs, the outer sides of the pieces in sets should 
be plain and smooth, and those spaces in which the 
springs work should be sunk the sixteenth of an 
inch below the surface of the other part, which pre- 
vents any annoyance to the cheeks from the promi- 



248 



MECHANICAL DENTISTRY. 



nence of the springs, or of the swivels by which they 
are fastened to the two pieces. 

It is here necessary to observe, that the object of 
these springs is merely to keep the two pieces in 
their places. The firmness and steadiness which the 
piece maintains during mastication, depend entirely 
upon the accuracy of the fit. It is only where there 
is a want of depth in the gum that these springs are 
necessary; in other cases they merely incommode 
the patient, without serving any useful purpose. The 
following represents a set of teeth with spiral springs 
made in the manner we are describing. 




Making Spiral Springs. — The operator may be 



MECHANICAL DENTISTRY. 



249 



so situated, that he cannot procure these springs 
from the manufacturer ; in that case it is well to 
know how they are fabricated. 

Take 16-carat gold wire, rendered elastic by being 
drawn through a diminishing series of holes in a 
steel plate until it attains the smallness of a fine 
sewing needle : insert one end of the wire into the 
hole, A, of the annexed apparatus, keeping tight 
hold of the other end, D, with a small hand- vice. By 
gently turning the handle, C, the wire will coil round 
the steel rod, B. 




A few trials will soon teach the operator how much 
force to exert with the hand in holding the end, D, 
in order to bring the coils closely together. It must 

m 3 



250 



MECHANICAL DENTISTRY. 



be remembered that the important properties of the 
spiral spring depend upon its elasticity ; therefore, 
annealing the wire in the process of drawing it down, 
would render it perfectly useless for these purposes. 

The length of the springs will depend upon the 
mouth of the patient, but generally it averages from 
an inch and a quarter to two inches. 

Fixing the Springs. — The spiral springs are 
fastened to the sides of the pieces by means of 
swivels or eyelets, which are rivetted to the piece ; 
a small portion of gold plate termed a washer, being 
soldered to the pin and countersunk into the bone, 
interposes between the eyelet and the bone, so as, 
during the movement of the spring, to diminish fric- 
tion and allow perfect freedom of action. 

Making the Swivels. — Swivels are made by cut- 
ting a piece of thick gold plate to a circular form, 
about the fourth of an inch in diameter, and having 
a hole in the centre ; a gold wire pin, the size of a 
common knitting needle, is then inserted, and sol- 
dered into the hole. The stages in the preparation 
of swivels are here represented. 

•ITT 



MECHANICAL DENTISTRY. 



251 



A is a circular disk of gold plate ; B, the pin ; C, 
both the preceding soldered together ; D, the rivet 
when finished. 

The eyelet, to the shaft of which the spring is fas- 
tened, is made of a piece of 18- carat plate, rounded, 
with hole in centre, to which a piece of wire, consti- 
tuting the shaft, is soldered. When finished and 
ready for use it represents the following. 



Fastening Swivels to Plates. — In some cases 
where the sockets are made of gold for entire and 
partial sets of teeth, and where mineral teeth are 
used for the back of the mouth, or where the 
block for the back grinders must be so shallow as to 
preclude the possibility of rivets being passed through 
it for fastening the swivel, it becomes necessary to 
solder the swivel to the sockets that the teeth rest 
upon. For this purpose a standard is required, 
made of strong gold plate, and of the following 
form, which represents both the front and back view 




of it. 



252 



MECHANICAL DENTISTRY. 




Position for Fixing the Springs. — The swivels 
upon which the spiral springs act should be placed at 
an equal distance from the central teeth, generally 
opposite the first or second bicuspids, or between the 
two. If the greatest exactness is not attended to in 
fixing the swivels opposite to each other, when the 
set is placed in the mouth, they will be found to 
shift their position, and by the slightest effort the 



MECHANICAL DENTISTRY. 



253 



patient makes to open his mouth, the teeth will 
twist ronnd. The following cnt represents a set of 
English mineral teeth set on gold with bone blocks, 
ready for insertion in the month. 




Artificial Teeth upon Engraved Suction 
Plates. — A very important improvement in the 
manufacture of suction plates has recently been 
made by Mr. Harnett, of New York, who in a 
communication to the American Journal of Dental 
Science, gives the following directions for their 
fabrication : — 

" After striking up the plate in the usual manner, 



254 



MECHANICAL DENTISTRY. 



engrave a border or line on the inner side of the 
plate ; the gold must be rather thicker than is usually 
employed, as the engraving has to be cut at least 
half through the plate. After having cut the border 
close to the edge of the plate, proceed to design, 
after the style of Louis XIV., the Renaissance, or 
any other elaborate mode, various scrolls, so that 
the whole of the inner surface of the plate may be 
covered, which will be sure to be the case if the 
styles which have been named be adopted : as the 
various ramifications of the scrolls must, necessarily, 
be so minute, that no part can escape. Of course, 
the ground-work of the scrolls must be cut away, 
and cut in deeply, and then friezed, as in this prin- 
cipally lies the advantage : as the friezing instrument 
(which is a tool used by chasers) has the power of 
levelling the ground-work, and, at the same time, 
making minute holes the size of a needle-point 
thereon, thereby creating a vacuum. When finished, 
the plate has the same appearance as the back of a 
Geneva watch-case, a locket, or any other piece of 
engraved jewellery." 

The author of the present Work has had several 
opportunities since the foregoing appeared of testing 
the value of this improvement, and is justified in stat- 
ing that the inventor has not overrated his discovery. 



MECHANICAL DENTISTRY. 255 

Before, however, the above process is commenced, 
the plate should be so far advanced towards comple- 
tion as to have the requisite number of rivets in- 
serted, upon which the artificial teeth are to be 
fixed. 

It is also important that the operator should sup- 
port his plate on the reverse side, so as to counteract 
the necessary pressure employed in using his tools ; 
otherwise the plate would be liable to serious injury. 

For this purpose, melt in a common ladle a suffi- 
cient quantity of jeweller's cement, which pour into 
a ring of iron of convenient size and depth ; when 
the cement has cooled to the consistence of thick 
cream, immerse the outer side of the plate in it up 
to its extreme edges, in which state it can be worked 
without the possibility of injury. When the process 
of engraving and friezing is finished, the operator 
has only to warm the surface of his plate and sepa- 
rate it from the cement ; after which the teeth, &c, 
can be fixed to the rivets in the usual manner. 



THE SURGICAL TREATMENT OF THE MOUTH PRE- 
PARATORY TO THE INSERTION OF ARTIFICIAL 
TEETH. 

Previous to the adaptation of artificial teeth, either 
upon a gold or bone socket, it is of the greatest im- 
portance to the ultimate success of the operation, 
that the mouth should be in a perfectly healthy con- 
dition; for otherwise, however beautiful and correct 
our artificial apparatus may be, it will be impos- 
sible for the patient to wear it with any degree of 
comfort. 

It is, therefore, necessary in all cases requiring 
artificial teeth, for the operator, before he proceeds 
to take his impression in wax, to examine thoroughly 
the condition of the gums, and of any natural teeth 
remaining in the mouth, and if he finds any loose 
roots or diseased teeth, to remove them immedi- 
ately, and defer taking the impression for a period 
varying from two .to six months, so as to allow 
the subsequent absorption of the alveoli to be com- 
plete. This may be materially assisted by the patient 
frequently washing his mouth and brushing his gums 
with the following astringent lotion : 



SURGICAL TREATMENT OF THE MOUTH. 257 

R Tinct. of Rhatany, 2 ounces, 



In some healthy constitutions the absorption is 
rapid, while in debilitated subjects it may occupy a 
longer period than the longest above mentioned. 

In cases requiring full sets, and where many dis- 
eased teeth or stumps have been removed, it will be 
found, when we come to fabricate our artificial sub- 
stitutes, that the maxillary arch, after absorption has 
taken place, is considerably contracted, so that it is 
impossible to insert the usual number of teeth of the 
same size as natural on the socket. Again, in cases 
for partial sets it will also be found, under the same 
circumstances, that the space has become so narrow, 
that the loss of room will frequently exceed the 
breadth of one tooth. In both these cases, the ope- 
rator should use smaller teeth, commencing from the 
centre with teeth of the original size, and reducing 
the size as he approaches the back of the mouth, so 
as not to be perceptible to the casual observer. 

It must be evident, from the above observations, 
that when artificial teeth are inserted in the mouth 



Pellitory, 



1 ounce, 
3 drachms, 
1 drachm, 
12 ounces. 



Terchlorid. Carbon, 

Alum, 

Water, 



Mix. 



258 SURGICAL TREATMENT OF THE MOUTH. 

too soon after the extraction of stumps or diseased 
teeth, and before a reasonable time has been allowed 
to elapse for the absorption of the alveoli or natural 
sockets, the base on which they are fixed, from the 
continual pressure exerted in mastication, will inva- 
riably render the apparatus liable to lose its perfect 
adaptation to the gum. Hence it is that a vacancy 
so frequently occurs between the gum and the plate ; 
a vacancy in which particles of food are deposited, 
where they not only become a source of pain and 
annoyance to the patient himself in consequence of 
then chemical decomposition, but from the same 
ground, render the breath extremely offensive to 
others. 



THE MANUFACTURE OF MINERAL TEETH. 



In England, the method of manufacturing mineral 
teeth, and the ingredients employed, have always 
been kept profound secrets, and it is to the valuable 
work by Drs. Goddard and Parker that we are in- 
debted for the following information on the subject. 

Materials employed. — These are pe-tun-tse, 
kaolin, clay and silex. 

Pe-tun-tse or Feldspar. — Few substances in 
the mineral kingdom are more widely diffused than 
this. It forms an essential part of most primitive, 
and many secondary rocks. It is found of various 
colours, but the only kind suitable for the above 
manufacture is pure white, or nearly so ; any colour 
alwaj^s arises from the admixture of some foreign 
substance. 

Chemical composition. — This mineral is com- 
posed of one atom of silicate of potash, added to 
one atom of silicate of alumina : or silex sixty-four 
parts, alumina twenty, and potash fourteen. 

Preparation. — The feldspar is first placed in 
pieces upon the fire, heated to a red heat, and 



260 MANUFACTURE OF MINERAL TEETH. 

suddenly quenched in water ; it is then broken into 
small pieces, and ground as fine as possible in a 
mortar. 

Kaolin. — This substance, called by the Chinese, 
kaolin, or China clay, is the result of the decompo- 
sition of feldspar by the united action of air and 
water. Feldspar is composed of equal quantities of 
silicate of alumina and silicate of potash. When 
the decomposition of the spar commences, it loses 
the silicate of potash by degrees, and when the pro- 
cess is complete, nothing but silicate of alumina 
remains. As the term kaolin is applied before the 
decomposition is perfected, it necessarily follows that 
this substance differs very much in its chemical cha- 
racters in different specimens, being, as before stated, 
sometimes silicate of alumina in a pure state, at 
other times mixed with a variable quantity of silicate 
of potash. In France, when pure, it is called kaolin ; 
when not so much decomposed, sable argileux ; and 
when but little altered from the state of feldspar, 
sable cailloteuoo. This sable cailloteux is used in some 
of the formulae that follow, but it is there called by 
its proper name, disintegrated feldspar. This condi- 
tion of the spar is marked by a loss of its trans- 
lucency, and a readiness to crumble, which is not 
perceptible in the uninjured spar. 



MANUFACTURE OF MINERAL TEETH. 261 

Chemical composition. — Kaolin, when fully de- 
composed, contains forty-eight parts of silex and 
fifty-two of alumina. Thus feldspar in decomposing 
loses two-thirds of its weight. Decomposed pumice- 
stone furnishes a very white kaolin, which has been 
used with success in the manufacture of mineral 
teeth. 

Preparation. — Kaolin is prepared by levigating 
in water. To do this, it is necessary to provide two 
tubs, one of which should have several holes bored 
in the side at different distances from the bottom, 
about three, five, and seven inches. These are to 
be closed by wooden plugs. This may be called tub 
No. 2. Take tub No. 1, and having nearly filled it 
with clean water, put kaolin into it, and stir it well : 
then suffer it to stand for ten or fifteen seconds. 
During this time the coarser particles will have fallen 
to the bottom by their gravity. Now pour off the 
upper portion of the fluid containing the finer parti- 
cles in a state of suspension, into tub No. 2 ; cover 
it, and allow it to stand until the whole of the kaolin 
has subsided. When this has taken place, draw off 
the supernatant water by means of the holes in the 
side, withdrawing the plugs for the purpose. After 
this, the mass must be dried in the sun, and pre- 
served for use in well-closed vessels. 



262 MANUFACTURE OF MINERAL TEETH. 

Clay. — Certain very pure and light-coloured clays 
are used for teeth: but as all kinds of clay will 
not answer, trial must be made of any peculiar kind 
to ascertain whether it contracts too much in the 
burning, or not. Pipe-clay cannot be used on this 
account. 

Silex or Silicic Acid. — This substance, which 
is known in mineralogy by the generic name of 
quartz, is widely diffused in nature. It exists more 
or less pure in the form of flint, white sand, and 
granular quartz, and is found in a state of absolute 
purity in rock crystal. Quartz should always be 
selected in the crystalline form, as it is the purest 
and most easy to prepare for use. 

Preparation. — Silex is prepared by heating it 
red hot, and quenching it in cold water. It is then 
easily pulverized, and should afterwards be levigated. 

All the above substances should be carefully dried, 
and preserved until wanted for use. 

Substances for colouring Mineral Teeth. — 
These substances are either metals in a state of minute 
division, or metallic oxides. They are used by mixing 
them in certain proportions with either the body of 
the teeth, or the enamel, or both. The most com- 
mon mode of applying them to the colouring of 
teeth, is to mix them with both the enamel and the 



MANUFACTURE OF MINERAL TEETH. 263 



body. The result is not absolutely certain, as the 
colour is deeper or paler according to the degree of 
heat employed, and the thickness of the enamel. A 
method has been tried which affords a fair prospect 
of success ; namely, to colour teeth and gums in the 
same manner as flowers, &c, are painted upon por- 
celain. The process is as follows. The oxides are 
formed into an enamel by being fused with some flux, 
of which one of the best is formed in the following 
way : — Flint glass, 12 parts ; red lead, 16 ditto ; cal- 
cined borax, 3 ditto ; powdered flint, 4 ditto. This 
produces an enamel the colour of which is derived 
from the metallic oxide. The enamel is to be pow- 
dered and mixed with oil of lavender, when it may 
be painted upon the teeth with a brush. When dry, 
the teeth are placed for the third time in the furnace, 
and the enamel fused. The only objection to this 
plan is, that the coat is very thin, and apt to lose 
its colour in the subsequent process of soldering. It 
would be well to try this mode of applying colour, 
by putting it on the body and covering it with an 
enamel, which should be transparent enough to shew 
the colour through. 

The following are the substances most usually 
employed in the colouring of mineral teeth : — 



264 MANUFACTURE OF MINERAL TEETH. 



Substances used. Colours given . 

1. Chloro-platinate of Ammonia Blue. 

2. Platina in filings or the spongy state Blue grey. 

3. Gold in filings or ground from the leaves Rosy red. 

4. Per-oxide of Gold Bright rosy red. 

5. Purple Powder of Cassius Rosy purple. 

6. Oxide of Titanium Bright yellow. 

7. of Uranium Orange yellow. 

8. of Zinc Yellow. 

9. of Manganese Purple. 

10. of Cobalt Blue. 

11. of Silver Lemon yellow. 



Should the operator be desirous of making the 
above preparations himself, the following formulas 
will be sufficient. 

Chloro-platinate of Ammonia. — Prepare some 
nitro-muriatic acid (aqua regia) by adding one part 
of nitric acid to two of muriatic or chloro-hydric 
acid. Put this into a common oil flask, and place it 
in a sand-bath ; drop in small pieces of platina, and 
allow it to remain until it has dissolved as much of 
the metal as it can. Then pour off the solution, 
which contains chloride of platina, into a larger 
vessel; dilute it with water to a certain extent, 
and precipitate it with a strong solution of muriate 
of ammonia. Separate the precipitate by means of 
a filter; then wash and dry it for use. 



MANUFACTURE OF MINERAL TEETH. 265 

Metallic Platinum. — This is used either in the 
form of filings, or of spongy platinum. The last is 
the best, and is prepared by compressing into a ball 
some of the precipitate obtained by the last process, 
and heating it to redness. 

Metallic Gold. — This is used either in filings, 
or in the fine powder which is precipitated from a 
solution of chloride of gold by means of proto- 
sulphate of iron. It may also be made by grinding 
gold-leaf with honey, and then washing away the 
honey with water. 

Peroxide of Gold. — Prepare a saturated solution 
of chloride of gold, by digesting metallic gold in 
nitro-muriatic acid. Dilute the solution, and preci- 
pitate it with aqua ammonise. In doing this, great 
care must be taken not to add an excess of ammonia, 
as this would re-dissolve the precipitate, and give 
rise to a powerful fulminating compound. The per- 
oxide of gold, when properly prepared, is of a brown- 
ish yellow colour, and detonates feebly when heated, 
losing its oxygen, and becoming converted into me- 
tallic gold. 

Purple Powder of Cassius. — This is a peculiar 
compound of gold and tin, in which the tin seems to 
play the part of an acid. Under this view, the tin 
may be called stannic acid, and the purple powder, a 

N 



266 MANUFACTURE OF MINERAL TEETH. 

stannate of gold. It has been found by Berzelius to 
be constituted as follows : — 



Gold 28 35 

Binoxide of Tin 64 00 

Water 7 65 



100 00 



In the preparation of this article, great care is 
necessary to obtain it always of the same quality. 
The following are the rules adopted by Thenard : — 
Prepare an aqua regia of one part of muriatic acid 
and two parts of nitric, to dissolve the gold. When 
dissolved, dilute it with distilled water, and filter; 
then add a much larger quantity of water. Also pre- 
pare, to dissolve the tin, an aqua regia, consisting of 
one part nitric acid and two parts distilled water, to 
which is to be added common salt, in the proportion 
of 130 grains to each pint of the diluted acid. The 
tin should be quite pure, and must be added to the 
acid by degrees : when the first portion is dissolved, 
add a second, and so on until the acid is saturated. 

The solution should be of a yellow colour, and the 
operation carried on very slowly in a cool place. 
When it is finished, filter the liquid, and dilute it 
with a hundred times its weight of distilled water. 



MANUFACTURE OF MINERAL TEETH. 267 

Then place the dilute solution of gold in a glass 
vessel, and add the solution of tin by degrees, inces- 
santly agitating the mixture with a glass rod, until 
the liquid partakes of the colour of port-wine. Allow 
it to stand, when large flakes of the purple will be 
deposited at the bottom of the vessel. Decant the 
solution ; wash and dry the precipitate on bibulous 
paper. 

Oxide of Titanium. — This oxide, which is called 
titanic acid, is found in a natural state, combined 
sometimes with the oxide of iron, and occasionally 
with pure oxide of uranium. This oxide is also 
found in a pure state, in which condition it is gene- 
rally employed. Its composition is — 



Oxide of Uranium 72 15 

Water 15 70 

Lime 6 87 

Oxide of Tin and Manganese 1 55 

Gangue 2 50 



It may be pulverized and levigated in water; then 
dried and preserved for use. 

Oxide of Zinc — This is prepared by precipitating 
a solution of sulphate of zinc with carbonate of soda, 
washing the precipitate, which is a carbonate of zinc, 
and heating it to redness to drive off the carbonic 

n 2 



268 MANUFACTURE OF MINERAL TEETH. 

acid ; after which it occurs in the form of a white 
powder. 

Oxide of Manganese. — This is found in a natu- 
ral and pure state. 

Oxide of Cobalt. — This is made by precipitating 
a solution of either the nitrate, sulphate, or muriate 
of cobalt, by carbonate of soda ; drying it, and cal- 
cining to a red heat, taking care to exclude the at- 
mosphere. It is in the form of a grey powder, and 
is composed of 100 parts of cobalt and 27*097 of 
oxygen. Its colouring power is so great, that one 
part will colour three hundred of borax almost black. 

Oxide of Silver. — This oxide or protoxide is of 
a deep olive colour. It is prepared by dissolving 
pure silver in nitric acid, and precipitating it with 
potash or soda, then washing it with a large quantity 
of water, and drying it in the usual manner. It 
consists of 100 parts of silver and 76 of oxygen. 

Preparing and Mixing the Body and Enamel. 
— The proper proportions of the various ingredients 
for the body having been accurately weighed, they 
are moistened by adding by degrees distilled water, 
and thoroughly amalgamated by means of a pestle in 
a Wedgwood mortar. The mass is now placed upon 
a slab of the same substance, as glass is so soft that 
it contaminates the materials. It should then be 



MANUFACTURE OF MINERAL TEETH. 269 

reduced to an impalpable paste by means of a Wedg- 
wood muller. 

When the paste is perfectly ground, it must be 
allowed to dry to the consistence of a stiff dough, 
and then beaten with a wooden mallet, or thrown 
repeatedly upon the slab with some force and for a 
considerable time. This process renders it solid, and 
prevents it from contracting so much in the baking 
as it otherwise would do. 

When the paste has been fully prepared, it may be 
kept for any length of time without injury, if it be 
prevented from drying ; nay, it improves by keeping, 
provided it be always moist. 

The preparation of the enamel differs but little 
from that of the body, except that the whole process 
requires, if possible, more care. Every particle of 
dust or metallic contamination must be carefully ex- 
cluded, and an ivory spatula used to handle the body 
and enamel in the mortar or on the slab. The ena- 
mel must be ground as fine as possible, and kept of 
the consistence of cream. 

In the following recipes for mineral teeth, the 
colours will be found to differ from those of most 
others, in consequence of the high temperature re- 
quired, and which contributes to render these teeth 



270 MANUFACTURE OF MINERAL TEETH. 



so beautifully translucent, and to make them resem- 
ble the natural ones with great accuracy. 

INGREDIENTS FOR MINERAL BLOCKS. 
No. I. 

Feldspar 3 parts. 

Clay 1 part. 

No. 2. 

Feldspar 4' parts. 

Kaolin 1 part. 

No. 3. 

Feldspar 24 parts. 

Silex 12 parts. 

Clay 6 parts. 

No. 4. 

Feldspar •. 24 parts. 

Silex 12 parts. 

Kaolin 6 parts. 

Starch (amidine) may be added to the body for 
making single teeth, in the proportion of two parts 
of starch to one hundred parts of dry material ; the 
starch being boiled to a jelly before mixing it with 
the body : but it will not answer to put starch in the 
body for carving blocks, as it renders them difficult 
to cut when dry. 



MANUFACTURE OF MINERAL TEETH. 271 



INGREDIENTS FOR MORE TRANSPARENT SINGLE 
TEETH. 

No. 5. 

Feldspar 18 parts. 

Disintegrated ditto 6 parts. 

Kaolin 2 parts. 

Flint „ 12 parts. 

No. 6. 

Feldspar 36 parts. 

Kaolin 3 parts. 

Silex 2 parts. 

No. 7. 

Feldspar 24 pennyweights. 

Silex 12 pennyweights. 

Kaolin 36 grains. 

No. 8. 

Feldspar 48 parts. 

Silex 32 parts. 

Clay 3 parts. 

No. 9. 

Feldspar 60 parts. 

Silex 32 parts. 

Kaolin 3 parts. 

No. 10. 

Feldspar 60 parts. 

Disintegrated ditto 40 parts. 

Silex 20 parts. 



272 MANUFACTURE OF MINERAL TEETH. 

No. 11. 

Feldspar 72 parts. 

Disintegrated ditto 48 parts. 

Silex 24 parts. 

Kaolin 6 parts. 

No. 12. 

Feldspar 100 parts. 

Disintegrated ditto 50 parts. 

Silex . 24 parts. 

Kaolin 12 parts 

ENAMELS FOR THE PREVIOUS INGREDIENTS. 
No. 1. 

Disintegrated Feldspar 24 parts. 

Flint Glass 12 parts. 

Feldspar 6 parts. 

No. 2, 

Disintegrated Feldspar 24 parts. 

Powdered Blue Canton Porcelain 10 parts. 

Flint Glass 3 parts. 

Borax 4 parts. 

This enamel is very fusible, and is used on bodie 
which are the same. 

No. 3. 

Disintegrated Feldspar 24 parts. 

Blue Canton Porcelain 12 p^arts. 

Flint Glass 6 parts. 



MANUFACTURE OF MINERAL TEETH. 273 



No. 4. 



Disintegrated Feldspar 24 parts. 

Flint Glass 12 parts. 

Feldspar 6 parts. 

No. 5. 

Feldspar 36 parts. 

Disintegrated ditto 18 parts. 

Clay 12 parts. 

No. 6. 

Disintegrated Feldspar 20 parts. 

Flint Glass 1 part. 



No. 7. 

Feldspar 12 pennyweights. 

Silex 12 grains. 

The best mode of enamelling, is with the fret 
which is next specified. It gives more trouble, but 
the beauty of the work repays the operator. 



FRET ENAMEL. 



Disintegrated Feldspar 28 parts. 

Kaolin 14 parts. 

Borax 12 parts. 

Flint Glass 8 parts. 

Potash 3 parts. 

Nitre 3 parts. 

N 3 



274 MANUFACTURE OF MINERAL TEETH. 

After fusing the above in well-luted crucibles in a 
furnace for about three hours, and allowing it to 
cool, the enamel must be removed from the crucibles 
by breaking them ; it is then to be finely powdered, 
after which add half a part of Canton porcelain and 
half a part of feldspar. Mix, and grind the whole 
firmly together. 

Gum Enamel. — Gum enamel may be made from 
any of the recipes given, except those which have 
clay in them. One grain of peroxide of gold will 
be sufficient to colour fourteen pennyweights of 
enamel. If the gold gives too bright a colour, a 
very small proportion of the oxide of titanium must 
be added. 

GRADES OF COLOUR FOR THE INGREDIENTS OF 
MINERAL TEETH, 

To thirty-seven pennyweights of dry material. 

The degree of colour is designated by the capital letter, aud the colour by the small letter. 
If A = the pure uncoloured enamel, then B = the lightest tint, and I = the deepest. 

Yellow. 



B. y. Oxide Titanium 2 grains. 

C. y. Ditto 3 grains. 

D. y. Ditto 5 grains. 

E. y. Ditto 6 grains. 

F. y. Ditto 8 grains. 



MANUFACTURE OF MINERAL TEETH. 



275 



Blue Tints. 

B. b. Spongy Platina H grains. 

C. b. Ditto 2 grains. 

D. b. Ditto 2\ grains. 

E. b. Ditto 3 grains. 

F. b. Ditto 4 grains. 

Greenish Tints. 

B. g. Oxide Titanium. . 3 grains ; and Spongy Platina . . 1 grain. 

C. g. Ditto 4 grains ; and ditto 1| grains. 

D. g. Ditto 5 grains ; and ditto 2 grains. 

E. g. Ditto 6 grains ; and ditto 2\ grains. 

F. g. Ditto 7 grains ; and ditto 3 grains. 

G. g. Ditto 8 grains ; and ditto 4 grains. 



GRADES OF COLOUR FOR ENAMELS. 

To four and a half pennyioeigJits of dry material. 



Yellow Tints. 

B. y. Oxide Titanium \ grain. 

C. y. Ditto ^ grain. 

D. y. Ditto % grain. 

E. y. Ditto 1 grain. 

Blue Tints. 

B. b. Spongy Platina £ grain. 

C. b. Ditto i grain. 

D. b. Ditto f grain. 

E. b. Ditto 1 grain. 

Greenish Tints. 

B. g. Oxide Titanium. . £ grain ; and Spongy Platina. . ^ grain. 

C. g. Ditto i grain ; and ditto f grain. 



276 MANUFACTURE OF MINERAL TEETH. 



D. g. Ditto. 

E. g. Ditto. 

F. g. Ditto , 

G. g. Ditto . 

H. g. Ditto, 

I. g. Ditto , 



f grain ; and ditto 

1 grain ; and ditto 

If grain ; and ditto 

1 j grain ; and ditto 

If grain ; and ditto 

If grain ; and ditto 



f grain. 

f grain. 
1 grain. 
If grain. 
H grain. 
If grain. 



Moulding Mineral Teeth. — The moulds for 
this purpose may be either made in plaster of Paris, 
or in brass or steel; those made in the latter are 
more durable, and if properly carved out, are more 
uniform as well as better. The cavities in which the 
teeth are to be moulded, must be one-fifth larger 
than the tooth required, as the body contracts in 
that proportion in baking. If plaster moulds are 
used, they should be perfectly dried, and immersed 
in equal parts of melted wax and resin to render 
them durable. Having well oiled the moulds with a 
brush and fine oil, the prepared paste for the body is 
to be worked or pressed into them. The cavities are 
not only to be filled, but a redundant portion must 
be left projecting, which is to be squeezed out by 
putting the back of the mould in a vice. 

If the teeth are plate teeth (American), and the 
platina pins have been previously cut from a wire of 
the proper size, they should have one end either flat- 
tened with a hammer, or a small head made on 



MANUFACTURE OF MINERAL TEETH. 277 



them, after which they may be inserted into the 
paste through the hole at the back of the mould. 
If they are to be pivot teeth, they require no pins, 
but a hole is made up the centre of the paste, by 
pushing a round piece of wire into the hole made for 
its reception on the top of the mould ; previous to 
which a little instrument of the shape of a gouge is 
introduced, to scoop out a small quantity of the 
body where the platina tubes are to be inserted. 
The teeth are then to be dried, which is done by 
placing the moulds on a stove, or in a warm place. 
When they are perfectly dry, the moulds may be 
separated, and the teeth will drop out. If they are 
then found to have any improper mark, it may be 
removed by cutting or scraping, and, if requisite, 
their shape may be slightly altered in the same 
manner. 

Moulding- Mineral Blocks. — It is better to 
make a block containing several teeth at once, and 
their appropriate gums. Having made the gold 
plate upon which the artificial teeth are to be fixed, 
it is to be the base upon which the block is moulded. 
The body is first rudely modelled in the plastic state 
to a proper form, taking care to make every part a 
little too large. The platina pins or tubes are now 
inserted opposite the centre of each tooth, and the 



278 MANUFACTURE OF MINERAL TEETH. 

model thoroughly dried. When dry, it must be 
carefully carved into a proper shape, imitating the 
natural teeth as nearly as possible, and making them 
about one-fifth too large. This part of the process 
requires skill and care ; skill to form the teeth of a 
proper shape, and care in not injuring the body • for 
in this state it is exceedingly frail. 

A full set of artificial teeth is usually made in 
three blocks, the front one containing the incisors 
and cuspidates, which must be carved and baked 
first, so that it may contract as much as possible ; 
the side blocks may then be modelled to it, without 
leaving any appreciable opening between the front 
and side blocks when they are all finished. 

Baking and Enamelling. — The teeth being 
moulded or carved in the manner described, should 
now be placed in a crucible having a little dry kaolin 
at the bottom, and subjected to a bright red heat in 
a charcoal fire. This degree of heat will not vitrify 
them, but agglutinates and renders them hard enough 
to receive enamel. The body in this state is termed 
biscuit, and the process, biscuiting porcelain. 

When the biscuit is cool the enamel must be ap- 
plied ; a process which requires much care. Having 
a quantity of the enamel prepared of the consistence 
of cream, and in several parcels of different tints of 



MANUFACTURE OF MINERAL TEETH. 279 

colour, it is to be applied to the face of the tooth, 
previously well cleaned, with a earner s-hair pencil, 
in a regular uniform coat, which should extend beyond 
the cutting edge of the tooth, so as to give that part 
the required transparency. If the tooth is of a 
uniform colour, it is only necessary, after it has 
dried, to make it regular and even, by means of a 
needle set in a handle. 

Generally the operator wishes to colour the tooth 
of three different tints, and, in the case of mineral 
blocks, to colour the artificial gums. To do this, 
several parcels of enamel of the proper tints must 
be mixed, (see Grades of Colour for Enamel, p. 275,) 
and each put on in its appropriate place. Great care 
must be taken not to let the rosy gum enamel touch 
the teeth, for if it does, a well-shaped edge will be 
formed around each drop. The tints on the crown of 
the tooth must be incorporated carefully, so as to 
blend or shade off into the other enamel, whilst the 
gum forms a sharp well-defined edge. To do this well, 
the coloured enamels should be placed on the tooth, 
and covered by a thin layer of enamel mixed with an 
increased quantity of water to render it fluid. 

It is usual to colour the part of the crown next 
to the neck of the tooth, yellow, and the tip, 
blue. If the predominant colour of the teeth to be 



280 MANUFACTURE OF MINERAL TEETH. 

imitated is yellow, the thin coat may be of yellow 
enamel, and on the contrary, if blue, this layer may 
be put on with blue enamel. 

The body of the tooth should always be coloured 
to harmonize with the enamel, or the effect is not 
good. When perfectly dry the teeth are ready to 
go into the furnace. 

The furnace is of the kind called a muffle furnace, 
containing a slide upon which the teeth are to be 
placed, and which is made of strong, fire-proof clay, 
with small grooves for the accommodation of the 
platina pins (if making flat teeth), which enables them 
to be laid in such a way that their cutting edges may 
be free, and not come in contact with anything 
capable of altering their shape. Before putting the 
teeth on the slide, it must be rather thickly covered 
with kaolin mixed with water, or with a layer of dry 
powdered silex, to prevent the teeth from adhering. 
Perhaps the best means, is a layer of dry kaolin. 
When pivot teeth are baked, they should be so placed 
in one of the grooves on the slide, that their edge 
may project and not become deformed. For this 
purpose the grooves should be made transverse, which 
is usually done on a separate slide, with a collar 
fitted with a stovepipe, which should be introduced 
into a chimney to produce a draught. 



MANUFACTURE OF MINERAL TEETH. 281 

Firing. — The fire must be kindled with small 
pieces of charcoal, as it produces but little ashes. 
Over this must be placed a quantity of anthracite 
(of a kind that is hard and produces white ashes) 
broken into pieces about the size of a walnut. To 
prevent chilling the muffle, the anthracite must be 
added in small quantities until the furnace is full ; 
when this is fully kindled, and the charcoal wholly 
burned away, the furnace is to be filled up until it 
is two inches deep over the top of the muffle with 
anthracite, and the stopper put into the upper open- 
ing, and well luted. The coal should, before this last 
filling, be well shook down under the muffle, as the 
greatest heat is required at that point. 

The teeth having been biscuited, and the enamel 
put on them, are to be laid as directed upon the 
slide. The muffle being in its place, the slide is to 
be carefully placed in it, and the door luted into the 
end of the muffle with fire clay. Care must be taken 
not to shake or stir the fire after this. 

The test-piece, which consists of a platina wire 
projecting from the end of a plug made to fit the 
hole in the cover last mentioned, is now to have one 
of the teeth of the same batch attached to the end 
of it, to enable the operator to judge of the progress 
of the baking ; and is to be introduced into its place. 



282 MANUFACTURE OF MINERAL TEETH. 

The second cover is then imposed, and tightly 
luted. 

Some prefer a door with three holes, in each of 
which a test-piece is introduced. The advantage of 
this is, that the operator can withdraw one test, and 
if it indicates an insufficient baking, he can go on, 
knowing that the remaining tests have not been 
exposed to the cooling process whilst being examined. 
This plan is very advantageous to beginners, but 
after some practice, the state of the baking can be 
judged of without cooling the test-piece. Some use 
no test-piece, but open the muffle and withdraw the 
slide partially, when they think that the teeth are 
sufficiently baked. If they are not finished, the 
slide is quickly returned, and allowed to remain some 
time longer, when it may be again examined. As 
soon as the test-piece on examination has indicated 
that the teeth are sufficiently baked, which is known 
by the enamel being perfectly fused and polished 
over the whole surface : the plug must be removed 
from the upper door, and the stopper put into the 
lower and luted tight. The furnace must then stand 
until the combustion has ceased and the whole has 
become cool. By this means the teeth will be very 
gradually brought down from an intense heat to the 
ordinary temperature. And the particles or mole- 



MANUFACTURE OF MINERAL TEETH. 283 

cules of which they are composed, will have had 
time to arrange themselves in the most compact 
manner. This is usually termed the annealing pro- 
cess, and the teeth are said to be either well or badly 
annealed. When they are well annealed they will 
stand sudden changes of temperature without injury, 
whereas, on the contrary, if badly annealed, the plate 
teeth will certainly crack under the blow-pipe, and 
thus be rendered useless. 



TO SEPARATE SILVER, GOLD, AND PLATINUM FROM 
FOREIGN BODIES. 



However cautious the operator may be in working, 
a certain quantity of the metallic material employed 
by him, is sure to collect, in the form of dust and 
filings, upon the bench and floor, and in the leather 
apron attached to the bench. This is technically 
termed the lemel or sweep ; and as it generally con- 
tains, besides the precious metals, a variety of sub- 
stances, as iron, zinc, bismuth, tin, &c, &c, it 
becomes necessary to separate the valuable portion of 
it from the worthless. We shall now, therefore, 
describe the methods by which this is effected. 

Silver. — For the purpose of separating the char- 
coal, cinders, and other large foreign substances 
from the metals, pass the sweepings through a fine 
wire sieve ; reduce the remainder to a fine powder by 
pounding it in an iron mortar, and sift again ; after 
which, submit the whole to repeated washings by 
immersing it in water, and agitating it by means of 
the hand or a stick. In the course of this process, 
the earthy matters, which are lighter than the metals 



TO SEPARATE SILVER, GOLD, ETC. 285 

contained in the dust, float through the water, which 
is then poured off, and the metals are left at the 
bottom. 

Having collected the residue, submit it in a glass 
vessel to the action of dilute nitric acid in the pro- 
portion of four parts of acid to two of distilled 
water ; facilitate the action of the acid by the heat 
of a sand-bath. If bismuth, copper, silver or iron 
be present, the acid will dissolve these metals, and 
any portion of iron or tin not dissolved, will remain 
in a state of oxide, leaving a residue composed of 
gold and platinum. 

The liquor is now decanted, and the residue re- 
peatedly washed with water, and added to the 
mother liquor. Filter this liquor through white 
bibulous paper, and treat the fluid with hydrochloric 
acid, until no more precipitate falls. The precipitate 
is the chloride of silver, 1000 parts of which should 
contain 753 of silver, which may be reduced as 
follows : — After washing the precipitate, and collect- 
ing and drying it upon a filter, mix it with small 
portions of chalk and charcoal ; put the mixture in a 
crucible, and submit it to the action of the furnace 
for half an hour. When cool, break the crucible, and 
the silver will be found at the bottom in the shape 
of a button, mixed with one or two per cent, of gold. 



286 TO SEPARATE SILVER, GOLD, ETC. 

Gold. — The remaining portion of the residue 
before mentioned, containing oxide of iron, tin, pla- 
tinum and gold, must now be treated with hydro- 
chloric acid, assisted by the sand-bath. The iron 
and tin will be readily dissolved, and when diluted 
with water, have only to be decanted. We have 
nothing now remaining but the gold and platinum, 
which can be separated by dissolving them in aqua 
regia. When this is done, dilute the solution with 
distilled water, and add a solution of sulphate of 
iron, made in the proportion of one ounce of iron to 
four of water; allow it to stand for three or four 
days, then pour off the liquor ; and the gold will be 
found at the bottom of the vessel in the form of a 
fine powder. 

It is always necessary to test the accuracy of the 
operation, so as to ascertain whether the whole of 
the gold has been precipitated from the solution, by 
adding another solution of iron; if any precipitate 
now forms, after the mixture has stood for twenty- 
four hours, it may be added to the former. 

Wash the precipitate with distilled water slightly 
acidulated with sulphuric acid, and afterwards with 
plain water. The powder may now be collected and 
dried on a filter in the same manner as the silver ; 
then reduced by mixing the precipitate with a little 



TO SEPARATE SILVER, GOLD, ETC. 287 

borax and nitre placed in a crucible, and then sub- 
mitted to the furnace in the manner before de- 
scribed. 

Platinum. — The remaining part of the solution, 
which now only contains platinum, is to be thus 
treated. To separate the platinum, suspend plates 
of zinc in the solution for two or three days, and by 
degrees the platinum will be precipitated in the form 
of a black powder. Wash this with water acidulated 
with sulphuric acid, in order to remove any zinc that 
may remain. Again dissolve in aqua regia, and 
evaporate the solution to dryness ; dissolve the residue 
in distilled water, to which add a solution of sal am- 
moniac, when a yellow precipitate will be the result, 
compound of hydrochloric acid, platinum, and am- 
monia. Collect and dry the deposit upon the filter ; 
place it in a crucible, and gradually raise the tempe- 
rature of the furnace. When the white fumes con- 
sequent upon the decomposition of the ammonia have 
passed off, increase the heat ; allow the crucible to 
cool, and collect the residue, which occurs in the 
form of a spongy mass, being that substance termed 
spongy platinum. 



CASES THAT OCCUR IN PRACTICE. 



Having, in the foregoing pages, given the student 
an account of the mechanical manipulations neces- 
sary for the construction and adaptation of partial 
or entire sets of artificial teeth, we shall proceed to 
enumerate a few of the cases that most frequently 
occur, that he may not experience difficulty from 
want of the knowledge necessary to enable him to 
construct such pieces of artificial work as will in all 
probability be required of him in private practice. 
For the purpose of illustration, we will suppose a 
case in which there is a loss of the six front teeth ; 
i.e., that the crowns of the three incisors and left 
cuspidate are lost ; and that the roots of the remain- 
ing left lateral and right canine have been extracted, 
as represented in the following cut. 

It will be obvious, in this supposititious instance, 
that on the four fangs four artificial crowns could be 
pivoted in the usual manner, leaving a vacancy on 
each side, which it is essential both for the comfort 
and appearance of the patient should be supplied. 
In the assumed case before us, it may be observed, 



CASES THAT OCCUR IN PRACTICE. 289 




that the back teeth remain, and advantage may be 
taken of them as affording a point of support for 
fastening a plate with clasps. Some patients, how- 
ever, have an objection to the use of clasps; and it 
sometimes does occur that the whole of the back 
teeth are lost, making it imperative on the operator 
so to construct his piece, that the whole number 
of teeth required may be firmly secured upon the 
four roots as above represented. In either case an 
impression of the fore part of the mouth must be 
taken, wooden pivots being previously inserted in 
the natural openings in the fangs ; and a plate must 
be made extending along the required space ; and on 

o 



290 CASES THAT OCCUR IN PRACTICE. 

the inside of the plate four metallic pivots are to be 
soldered, in precisely the same manner as for the 
insertion of a single tooth on plate with pivot : see 
above, p. 231. 

Insertion of single teeth on a Plate. — The 
method usual with some dentists for the insertion of 
a single tooth, consists in carrying the gold plate 
only as far as the tooth on each side of the vacancy ; 
while attached to the plate there is a fine gold wire 
that is made to clasp the two neighbouring teeth ; as 
here figured. 




This method of fixing a single tooth, besides being 
objectionable as shewing the gold in the mouth, is 
also highly injurious to the adjoining teeth, to which 
the wires are fastened, insomuch that by the continual 
friction of the latter upon the teeth, their substance 
is soon destroyed, the teeth are loosened in con- 
sequence of the want of solidity and firmness in the 
artificial substitute, and are generally lost in the 
course of a few months. 

The important object to be attained, and that the 



CASES THAT OCCUR IN PRACTICE. 291 

operator should constantly have in view, in con- 
structing artificial teeth, is, to extend his work over 
such a surface of the gum, that the fastenings by 
which the teeth are secured, may be far enough back 
to be quite out of view. The clasps also should be 
sufficiently wide to distribute the force, and prevent 
those serious and destructive consequences that re- 
sult from the employment of wires. 

The plan that we adopt and recommend for the 
insertion of a single tooth in front, is, to extend the 
gold plate around the sides of the mouth as far as 
the first molars or bicuspids, and to attach broad 
clasps to the ends of the plate. In some cases where 
no natural division exists between the teeth, it will 
be necessary to separate them by means of a file. 
A tooth constructed on this plan would be as here 
figured. 




It may happen that on account of the loss of teeth 
on one side of the mouth, an attachment can only 

o 2 



292 CASES THAT OCCUR IN PRACTICE. 



be made to a single tooth, or to those of the same 
side ; in the former case the piece would be as follows. 




Where the plate and clasp are of sufficient strength, 
this arrangement will subserve even the purposes of 
mastication. 

In similar cases it is desirable, where practicable, 
to take two points for the support of the piece, as 
here shewn. 



CASES THAT OCCUR IN PRACTICE. 293 

In other cases, where there is only one tooth re- 
maining for the attachment of the artificial tooth, 
and where that one is a bieuspis or molar, it is 
obvious that no great firmness can be gained. Some 
assistance, however, will accrue from the pressure 
of the opposing tooth, to prevent the new one from 
rising in its socket. 

The cases where success may be anticipated, are 
those in which the tooth remaining in the mouth is 
firm and healthy, and of a flat or angular shape, so 
as to enable the operator accurately to adjust to it 
his clasp for securing his piece; in such cases the 
work will be serviceable for mastication. 




In cases of loss of the first bieuspis, the operator 
should extend his gold, and make his fastenings to 
the first molar ; as thus : 



294 CASES THAT OCCUR IN PRACTICE. 




In loss of the two centrals of the upper jaw, the 
method generally adopted is, to secure the piece by- 
means of wires ; thus : 




The same objections lie here as in the former in- 
stance, against the employment of wires. It is far 
preferable to secure the piece either to the second 
bicuspis, or first molar, by broad clasps ; as here 
represented. 



CASES THAT OCCUR IN PRACTICE. 295 

In cases where the four upper centrals are lost, 
instead of fastening the substitute teeth to the two 
canines, as is generally done, it is better to extend 
the gold frame as far as the first molar on each side, 
so as to embrace the neck of each tooth with a strong 
wide band, as figured below. 




Great inconvenience is frequently experienced by 
patients from having two or more single teeth inserted 
separately on gold plates, as for example the two 
first bicuspids; in those cases, we generally prefer 
the plan of fixing them on a single plate, as follows. 




Occasionally only the first molar remains in the 



296 CASES THAT OCCUR IN PRACTICE. 

mouth, to support a large piece of artificial work. 
In these cases the gold plate must be run as high up 
as possible over the edge of the gum, on the side of 
the mouth, opposite to where the fastening has been 
made : as here represented. 




Cases also occur in which only two molars remain j 
the gold in this, and similar instances, should extend 
as far back in the mouth as possible ; inasmuch as it 
gives steadiness and support to the piece during mas- 
tication ; as thus. 



CASES THAT OCCUR IN PRACTICE. 297 

Where the whole of the upper teeth are lost, the 
usual method adopted for the support of an artificial 
piece, is, to fit a plate or bar, to the inner surfaces 
of the lower teeth, extending the gold over the crowns 
and outer surfaces of the molars and bicuspids, as 
far as the edge of the gum, in the form of caps. 
To the plate covering the latter are soldered the 
swivels. 

This clumsy and inartistic contrivance is unneces- 
sary for the support of an upper set, siuce if the 
gold plate be accurately made, friezed and engraved 
as before described, and carried well over the angles 
of the jaw; and if the bite be accurately adjusted, 
the plate will not require the assistance of spiral 
springs for its support. And even should the case 
not admit of gold, from the shallowness of the gum, 
the operator can have recourse to dentine. 

Artificial Palates. — The dental operator is 
seldom called upon to furnish these at the present 
day, when the treatment of syphilis and the admi- 
nistration of its antidote, mercury, are so much 
better understood. Whether palatal deficiencies be 
congenital, as in cases of hare-lip, or whether they 
be the result of disease, is matter of little importance 
to the dentist. 

Dr. Brown, of New York, who has written upon 

o 3 



298 CASES THAT OCCUR IN PRACTICE. 

this subject, divides the malformation into two kinds, 
simple and compound; the former comprising the 
cases in which the object is merely to supply a defi- 
ciency of the arch ; the latter, those where the 
apparatus employed requires to have artificial teeth 
attached to it. 

The evils to be remedied by artificial palates are, 
first, defective enunciation ; second, the escape of 
solids and fluids through the nasal passages ; thirdly, 
difficulty of swallowing. 

The simple malformation, as we before observed, 
is a want of palate either congenital or from disease. 
"When arising in the former way, it involves a 
greater or less declivity in the palatine arch, at- 
tended with a perfect denture; and the object is, to 
attain a proper enunciation, and a prevention of the 
passage of fluids through the nares. 

To effect these ends, a plate must be constructed 
to fit the upper part of the palate, with a second 
plate soldered to the former, having the proper curve 
of the palatine arch. This is to be supported by 
springs or clasps attached to the molar teeth on each 
side. 

The second cases, or those originating in disease, 
exhibit an aperture in the palate ; the denture being 
perfect here also. 



CASES THAT OCCUR IN PRACTICE. 299 



To meet this condition, a plate must be made that 
will cover the greater portion of the arch ; and upon 
the centre of that part of its surface that comes in 
contact with the edges of the spring, are soldered 
several eyelets, to which a piece of soft sponge is 
fastened, considerably larger than the external open- 
ing of the cavity. The sponge, when attached to 
the plate, is pressed into the cavity in a dry state. 
Thus when moistened by the mucus of the nose, the 
plate will be closely drawn to the palate. The fol- 
lowing represents such a plate with sponge attached. 



The compound description of malformation exists 
when any or all of the natural teeth have been lost, 
and artificial substitutes are fixed to the plate : as 
represented in the following cut. 

In all cases of deficiency of palate, the operator 
must bear in mind, that no mechanical contrivances 
are to be applied to the mouth, until not only the 
natural teeth, but the bony, muscular, membranous, 
and other tissues in the cavity are in a perfectly 
healthy condition. It is essential also that an im- 




300 CASES THAT OCCUR IN PRACTICE. 




pression of the palatal arch and teeth should be 
taken in the usual manner, and a plate accurately 
adjusted to a plaster model, and fastened to the 
molar teeth by means of clasps. The arrangements 
for cleanliness should be such that the patient can 
with ease remove the plate ; and whenever sponge is 
attached, it should be renewed daily. 



DENTONOMY, AND ITS PRACTICAL IMPORTANCE. 



There is one fact connected with all organic beings, 
and which is of peculiar importance in whatever arts 
or sciences are founded upon the study and wants 
of the human frame especially; we mean, the fact, 
that the body is a whole, and that all the parts 
represent, involve and characterize the whole, and 
are in the strictest keeping with it. This fact grows 
out of the unanimity of use that subsists among the 
parts, and makes them all minister to the general 
and precise end of the system to which they belong. 
Therefore it is that the face, in every instance, is the 
proper face of the individual who owns it, often re- 
flecting his character with notable and accredited 
correctness. Hence the science of Physiognomy. And 
therefore also it is that the parts and members of one 
person are never exactly similar to those of any other 
person. Reason and experience alike attest that this 
is the case with the human teeth. If " quot capita, 
tot sensus," be valid, so also it is equally veracious 
to say, " quot capita, tot dentes." Hence there may 



302 



DENTONOMY, AND ITS 



as justly be a science of Dentonomy as of physiog- 
nomy; and indeed for the purposes of the dental 
art, it is highly necessary that such a science should 
be admitted, and so far as it does not yet exist, that 
it should at once be instituted. This science, and 
the art founded upon it, will recognize the manner in 
which the teeth comport, in their form and qualities, 
with the whole and the parts of their individual pos- 
sessor, and specifically with his face. 

Its practical bearing on dentistry is obvious enough. 
For though the teeth are small organs, yet are they 
highly expressive and representative ones, and belong 
(as we said above, pp. 77, 78) to the most speaking 
parts of the human system. The slightest observa- 
tion suffices to shew how vast their diversity in dif- 
ferent subjects, and how much that diversity adds to 
the character of the countenance. Thus where they 
are lost they require to be substituted by artificial 
teeth of a similar kind, or at least which will harmo- 
nize with the features of the face. In many cases, 
however, no guide is afforded to the dentist whereby 
to suit his artificial teeth to the patient, except his 
own good taste and artistic perception, based upon, 
and improved by, a scientific habit of observation. 
And a subtle order of observation it is that is here 
required ; one which is among the deepest faculties 



PRACTICAL IMPORTANCE. 



303 



brought into exercise in the whole compass of the 
dental art. 

If it were aught so palpable as a new nose, or a 
new leg, that was to be adapted to the face or the 
body in place of a natural member unfortunately 
lost, it would be at once admitted that, as a general 
rule, the succedaneous nose should resemble its pre- 
decessor, and that if a Roman had been destroyed, a 
snub should not occupy its vacant seat ; and in like 
manner that the wooden or corken leg should have 
some considerable similarity both to the one lost, 
and to the one left; so that the stout limb of the 
porter should not be paired with a fac-simile of the 
lean and shrunken shank of the clerk ; nor the mus- 
cular limb of the male, with a resemblance of the 
rounded and beautiful member of the female. And 
yet artificial teeth, though comparatively minute, 
may be as strikingly incongruous with the person of 
the individual, as even a new nose that subverts 
the expression of the face, or a new leg that is too 
long or too short for its unlucky wearer. It is true 
that in this case the observer may be at a loss to 
know what feature it is that is so false to the rest of 
the visage, yet he will certainly have a keen percep- 
tion that something is very wrong, if he cannot at 
once determine it. Only let the reader conceive the 



304 DENTONOMY, AND ITS 

delicate row of pearls suitable for an aristocratic 
beauty, inserted into the mouth of an able-bodied, 
hard-featured labourer, and he will see how widely 
erroneous a dentist might be, if he did not exercise a 
discriminating judgment in fitting the teeth to the 
individual. And we have no hesitation in asserting, 
that for want of attention to this subject, the dentist 
often confers upon his patient an idiotic element of 
expression, which is particularly manifest during 
laughter, when the artificial denture grins forth 
horribly, — a huge mass of insignificant formality, 
making it impossible for the mind to image itself in 
the countenance. Such cases violate whatever is 
even mechanical in the dental art, and reduce the 
practitioner to something lower than a common 
carpenter. He may still be competent to make 
pegs for mutilated pensioners, but he should at all 
events cease to profess to imitate the natural parts 
of that system which is alive, and where harmony is 
essential. 

We are ashamed to say, that in treating of this 
subject, we know not where to look for written in- 
formation. Unquestionably all good dentists have 
had a correct, artist-like feeling which has guided 
them right, to a certain extent, in practice : but the 
feeling has not been analyzed, or made the germ of 



PRACTICAL IMPORTANCE. 



305 



a proper science, as Ave predict that it will be in pro- 
portion as our art advances. Those who go blindly 
right are apt sometimes to go blindly wrong. We 
must no longer be content with a bare instinct in a 
matter so vitally important, but distinct observation 
must be cherished, and thought, and ultimately 
science, and the rules of science, be founded there- 
upon. The dentist must divide teeth into certain 
great classes, and in the same manner, faces also ; and 
paralleling the former with the latter, draw up laws 
that will, in all cases, enable him, with some confi- 
dence, to suit the artificial teeth to the features of 
the face ; and thereby, in a certain logical manner, 
to the teeth that have perished. 

It is little that we can yet do to facilitate the 
science which we have termed Dentonomy, but the 
following is at any rate a well-meant contribution, or 
perhaps an attempt only at a contribution. 

In Dentonomy then we at present particularize 
four kinds of teeth corresponding to four kinds of 
faces. 

1. There is the oval face, and answerably thereto 
the filbert-shaped teeth, having extremely long ena- 
mel, great beauty of appearance, and an oval form 
at the upper part of their front surfaces, near the 
gum. 



306 



DENTONOMY, AND ITS 



2. The round face; the teeth being short and 
square j their edges thick and broad, and their front 
surfaces nearly flat ; and the jaws approximating for 
the most part perpendicularly. 

3. The third variety occurs in very thin subjects 
with high cheek bones; the teeth being usually 
middle-sized, long and narrow ; the incisors thin, 
and the cuspidates rounded and pointed ; the bicus- 
pids pointed, and the molars deeply indented. 

4. There are other persons with particularly broad 
faces; the central teeth also being proportionally 
broad and thin, and their back surfaces deeply in- 
dented; the laterals mostly ill-formed and small; 
and the canines, bicuspids and molars, partaking of 
the characteristics of the centrals. 

The above, however, is a mere sketch, which we 
invite the profession to correct, fill up and extend, 
out of the abundant opportunities which are every 
day presenting themselves : for we are quite sure 
that there is, at this day, enough of genius among 
our brethren on both sides of the Atlantic, to place 
the subject, in a short time, on a satisfactory, i.e., 
a scientific foundation. Above all, we call upon those 
dentists who have already entertained the subject in 
their minds, to record and publish their experience ; 
and especially those who have been employed in the 



PRACTICAL IMPORTANCE. 



307 



manufacture of artificial teeth, and who must be 
presumed to have proceeded upon the rules of a true 
Dentonomy. For we know of no branch of dental 
study that is more likely than this to reward the 
attentive observer ; of none that will better develop 
the mind and resources of the noviciate dentist. It 
is in fact one of those fine points that must make 
the difference between the man of talent and the 
man of mere routine ; and characterize the prudent 
adaptations performed by the one, as contrasted with 
the rude, malapropos carpentry attempted by the 
other. 

We may be permitted to observe in conclusion, 
that we by no means wish it to be understood, that 
the artificial teeth should always imitate the natural 
ones, even in their defects (as in class four above 
specified), but only that general characters should 
be preserved, and in a word, that keeping should be 
ever maintained : so that the Dentist may be, to the 
proper extent, an Artist also. 



DENTAL EDUCATION. 



We have now, to the best of our ability, conducted 
the reader who has followed us thus far, through the 
medical and mechanical knowledge, that in its skilful 
application constitutes the dental art ; and as it is 
our design to recite our own experience, whether 
negative or positive, wherever it may seem to be 
useful to others, we shall in conclusion endeavour 
to draw upon that experience, to give an outline of 
the education which it is desirable the dentist should 
possess, and of the etiquette and manners to be ob- 
served by him in practice. It is not our aim, how- 
ever, to set up as a dental Chesterfield, or to put 
ourselves forth as Master of the Ceremonies to our 
elder brethren of the profession, (of whom we are a 
learner, and not a teacher,) but simply to address a 
few available hints to the younger aspirants after 
public confidence and dental honours. Let us not, 
therefore, be misunderstood; nor let it be thought 
that we wish to imply that we ourselves possess all 
the endowments and requisites which nevertheless 



DENTAL EDUCATION. 



309 



we recommend it to our rising members to acquire, 
while they yet have time, from the earliest dawn of 
their studies. 

It is obvious that a classical education is of advan- 
tage in every profession. To the dentist, however, 
it not merely confers indirectly the benefit of polish- 
ing the mind and speech of its possessor, and of 
accrediting him at the general court of the sciences, 
and in the most cultivated classes of society ; but it 
is also directly valuable in enabling him to peruse 
classical works upon the teeth, and to gather the 
opinions of those venerable writers, as Aristotle, &c, 
whose views on some departments of dental physiology 
have hardly been substantially increased even at this 
day, when so many branches of knowledge have been 
aggrandized by new discoveries. 

For even wider reasons than these, the student 
should make himself acquainted with the French and 
German languages, in which so much is written that 
is worthy to be read ; and which indeed are so often 
necessary for the common purposes of social inter- 
course with patients. It is a pitiable sight to see 
two individuals, for want of a medium of communi- 
cation, making vague signs, like infants ; or with 
vexation and shame depicted upon their faces, utter- 
ing strange vowels, like animals : the unsatisfactory 



310 



DENTAL EDUCATION. 



interview being concluded without the one under- 
standing the wants of the other ; or if he have guessed 
them, without his knowing but that something is 
still unthought of and undone that was included in 
the purpose of the patient's visit to his dental adviser. 
Whatever practitioner has been once or twice in this 
predicament, will heartily wish that it had been his 
lot to have acquired the modern languages while he 
was yet a pupil, and before the absorbing occupations 
and unyielding habits of after life have rendered it 
difficult or impossible to submit again to the necessary 
schooling. 

There is a similar reason, though of a still more 
limited kind, why the dentist should have a general 
knowledge of the anatomy and physiology of the 
human body, as why the medical and surgical prac- 
titioner should possess the same. It is not that 
general anatomy is all made use of in either profession, 
for such is not the fact ; yet it is highly educative to 
the mind, and is the best ground for the acquirement 
of that special anatomy, diverse in each case, that 
belongs to the medical, surgical, and dental profes- 
sions respectively. Moreover it is impossible rightly 
to comprehend a part of the human body without 
having some knowledge of the whole ; so unanimous 
is the organic system, and so much do the parts 



DENTAL EDUCATION. 



311 



depend upon the whole,, and vice versa. Therefore 
here, in the very nature of the body itself, there is 
a cause why the dentist should be educated in general 
anatomy and physiology. 

Comparative anatomy has also an educative though 
remote bearing upon dental studies, and it tends in 
particular, as hitherto received, to shew the import- 
ance of the teeth as representative organs ; i.e., as 
means of classification. It may, therefore, where 
there is opportunity, be justly added to the curri- 
culum of the dental pupil. 

That special, human anatomy that concerns the 
teeth, and which embraces nearly all the parts and 
organs of the human mouth, jaws, and face, must 
be thoroughly mastered by the student. Vague 
knowledge will not be sufficient here. Precise ana- 
tomical views of the form, character, and relative 
position of all the parts : precise mechanical views 
of their combined and separate action : precise phy- 
siological views of their uses in health : these must 
be acquired, and through life retained; otherwise 
the student will never be a truly accomplished den- 
tist ; otherwise the practitioner will never deserve, 
or keep up, his reputation, on the basis of his useful- 
ness. For this is the immediate ground- work which 
the dental art possesses in the knowledge of the 
human body. 



312 



DENTAL EDUCATION. 



The dental profession is in one sense an offset of 
the medical. Hence the dentist must be acquainted 
with the general principles of medical practice. This 
is necessary to give breadth to his views, and to 
enable him to acquire, and assimilate, the special 
principles of dental medical practice. Respecting 
the latter, however, the same overwhelming necessity 
of mastering it exists, as we before dwelt upon in 
speaking of special dental anatomy. The pathology, 
treatment, materia medica, &c, &c, of dental disease 
must become exactly known to the student before he 
is fit to practice his calling. This is the peculiar 
heritage which belongs to him as a peculiar member 
of the medical profession. 

Dental surgery is also a part of general surgery : 
and principles must be learnt from general surgery, 
before dental surgery can be a rational practice ; or 
before its special principles can be fixed and appre- 
ciated. A connexion with the parent stem must be 
always maintained through a general knowledge of 
the principles of the wider practice; and this will 
give sap to the branch, and empower it to become 
fruitful. Nevertheless the branch is too important 
not to be a distinct study. It has its own cultivation, 
and this must be both precise and diligent. In some 
respects dental surgery has the advantage of its 
parent. Its field is peculiarly small and definite : 



DENTAL EDUCATION. 



313 



and surgical mechanics are perhaps nowhere so neatly 
applicable as to the teeth and mouth. It is wonderful 
what is done by the scientific dentist in that small 
space ; in the minute fractures and dislocations that 
there take place ; in the application, if we may use 
the phrase, of permanent splints ; in the removal of 
diseased parts, &c, &c, &c. The dental art, in its 
perfection, is the very beau ideal of a pure mechanical 
surgery. 

The relation of dentistry to mechanics is twofold : 
there is the mechanics of the art itself, to which we 
have just alluded : there is also the mechanics pre- 
liminary in a manner to the practice of the art, and 
which forms a main subject in this Second Part of 
the present Work. The two are both necessary to 
dentistry ; for, as an admirable writer has with great 
force observed, " no art is complete, unless another 
art, that of constructing the tools and fitting them 
for the purposes of the art, is embodied in it. 33 Both 
of these arts of course flow from the general prin- 
ciples of mechanics, with which, therefore, the student 
should make himself well acquainted ; as well as with 
all the special principles and applications which are 
necessary in practice. Upon the mechanical ability 
and tact of the individual, will greatly depend his 
success as a dentist. If these conditions are wanting. 



314 



DENTAL EDUCATION. 



he may indeed be a physician-dentist, but a surgeon- 
dentist he never can be. We may add that the grand 
triumphs of the dental art are nearly all of them 
mechanical. 

We hold that the student ought to give his atten- 
tion, for a period of from three to five years, to the 
execution of artificial work of all descriptions ; until 
in fact he has attained to skill and dexterity in the 
various branches thereof. During the same time he 
should also take constant opportunities of fitting his 
work into the mouth, and performing the various 
dental operations. If he have well availed himself 
of circumstances to this extent, he will have no lack 
of confidence and expertness when he comes to prac- 
tice for himself. 

To whatever branch of the dental art we turn 
ourselves, some knowledge of chemistry is obviously 
necessary for the student to acquire. In both the 
first and second Parts of this treatise, particulars 
occur which demonstrate how closely chemistry is 
connected with dentism. 

A slight consideration of the various subjects which 
have been successively brought under the reader's 
view in the foregoing pages, will serve to shew that 
dentism embraces portions of many sciences, without 
which it would be empty and ineffective. Thus a 



DENTAL EDUCATION. 



315 



whole group of arts is requisite to minister to the 
human teeth. These, of course, however indispens- 
able, are among the lowest organs of the body ; and 
what a view does this present us with, of the ma- 
chinery required for the entire system, to maintain 
it in health, and to cure it when diseased ! Nor is 
such a consideration without its value to the student's 
mind, inasmuch as by shewing him the wide- spread 
ramifications of his art, it gives it a broader basis in 
nature and society, fills up its outlines, and to the 
utmost utilizes and ennobles it. 

But let the student be ever so well informed in his 
science and accomplished in his art, there are still 
other qualifications which he must possess, in order 
to constitute him a successful and useful practi- 
tioner. 

In the first place, when operating, he must learn 
to command nerve and firmness, and never to ex- 
hibit the slightest alarm under trying circumstances. 
Without reference to the station of his patient, he 
must be calm, bold and precise. He must not suffer 
himself to be influenced in any degree in the execu- 
tion of his professional duties, against the dictates of 
his better judgment. He must strenuously cultivate 
an easy, gentlemanly deportment in the surgery, 
combining the proper degree of dignity with a becom- 

r 2 



316 



DENTAL EDUCATION. 



ing sympathy for his patient ; so far as some tender- 
ness is consistent with the offices he is called upon to 
perform. He must be governed by a high sense of 
honour, and express it in a friendly politeness that 
will secure confidence, reassure timidity, and give 
the public just grounds to form a favourable opinion 
of his ability and integrity. He must observe the 
utmost cleanliness in his person, recollecting that it 
is the patient's mouth which he has to treat. His 
hands, his instruments, and the utensils employed 
in the surgery, must in this respect be scrupulously 
attended to. In the course of his manipulations, he 
must not touch the face further than is requisite to 
support the part he is about to operate on. Under 
no circumstances must he make a display of his in- 
struments, nor after one patient has been treated, 
permit another to enter the apartment before all the 
instruments, cloths, glasses, &c, previously used, 
have been removed. He must take no snuff, and 
eschew tobacco. In short, he must be amiable, 
agreeable and inoffensive. 

It is hardly necessary to say, that a true moral 
feeling is the safest ground from which nearly all the 
above qualifications may flow. For they will be 
more likely to endure, and to brave trial, if they 
proceed from within, and are the cordial nature of 



DENTAL EDUCATION. 



317 



the man, than if they are merely assumed for the 
occasion. And indeed the moral character is of the 
highest importance in one who is brought so near to 
the sacred human person as the dentist often is in 
the pursuit of his duty. But this is too obvious as 
well as too serious a subject to require to be dwelt 
upon here. We will only remark, that the mens 
conscia recti, is the very root of calmness, and of the 
best kind of courage, as well as of those amenities 
of manner which are the most certain to be accept- 
able to others. We commend the acquisition and 
preservation of it to the rising generation of den- 
tists ; and. this is the last and best advice that we 
have to offer. 



GLOSSARY 



OF SOME TERMS USED IN THE WORK. 

Absorbed. — Wasted or removed. In the human body there are 
an immense number of vessels, called absorbents, whose office it is to 
remove any foreign or extraneous matter from the system, or from 
any particular organ. When therefore these vessels are brought into 
action either by pressure or inflammation, the part where they act is 
said to be lessened or removed by absorption. 

Alkaline. — A term embracing certain chemical agents that neu- 
tralize acids ; and therefore used as correlative or opposite to acid. 

Alloy. — A mixture of two metals. 

Alveolar Processes. — The sockets that contain the teeth in the 
jaw-bone. 

Amalgam. — The union of a metal with mercury. 

Bicuspids. — The two teeth next to the canines are so called, on 
account of having two points. 

Calcareous. — An earth containing lime. 

Caries. — Ulceration, decay or mortification in bones. 

Chronic — An adjective applied to diseases of long standing, the 
term being employed to convey the opposite to acute, or sudden 
diseased action. 

Cuspidates. — The canine or eye teeth are so termed from cuspis 
a point ; they are the third from the centre teeth. 

Diagnosis. — The art of distinguishing, by symptoms, one disease 
from another. 



320 GLOSSARY. 
Febrile. — Feverish. 

Gelatin. — A jelly, which forms one of the ingredients in bones of 
all kinds, and which may be extracted, either by boiling or digesting 
the bone in caustic potass. 

Incisores or Incisors. — The four front teeth in each jaw are 
so called to express their office, which is to divide or cut the food. 

Maxillary Bones. — The jaw bones. 

Membrane. — A term applied to the thin skin that invests different 
parts and cavities, &c. of the body. 

Molar Teeth. — The three back teeth on each side of the jaws, 
are so called, from molar e to grind. 

Morbid . — Diseased. 

Muscle. — What is commonly termed flesh : the muscles are the 
motor powers of the body. 

Narcotic. — Drugs that induce torpor or drowsiness are narcotics. 
Osseous. — Bony. 

Pathology. — The doctrine of disease. 

Periosteum. — The membranous skin that covers the bones, and 
envelopes the fangs of the teeth. 
Phthisis. — Consumption. 

Physiology. — The doctrine of nature ; now generally limited to 
mean the doctrine of organic bodies. 

Suppuration. — The process by which matter is formed when an 
organ or part is inflamed. 



THE END. 



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